Preferred and referred: New study shows male specialists are favoured by both male and female referring doctors

Doctors in general prefer to refer their patients to male doctors—a bias that has led to surgeons and other specialists who are male to get the lion’s share of physician referrals and to also get paid more from referrals. For female specialists, not being the referral of choice could create an ongoing cycle of lost opportunities to become better at their speciality through repeated practice, leading to more referrals going to more experienced—and, likely male—colleagues. These were the key findings from an Ontario Medical Association study that looked at 2018-2019 provincial billing data for 7.6 million new referrals made by 32,824 physicians to 13,582 surgeons and other specialists in Ontario. “We found physicians of both genders disproportionately referred to male specialists, affecting the total number of referrals and hence total remuneration of each specialist,” wrote the study authors. The study also found a difference of 4.7% in revenue per referral between male and female specialists, a finding that the authors said is consistent with prior research suggesting part of the pay gap in referrals may be attributed to male specialists having more lucrative referrals and more procedural referrals “Differences in revenue per referral may be driven by several mechanisms, including systematic differences in the complexity of referred patients or gender-based differences in billing or practice style,” wrote the authors. “It is not clear whether higher referral revenue for male versus female specialists in the one-year follow-up period was beneficial and appropriate or reflected overuse. While effect sizes were small, the cumulative consequences over time for lifetime earnings may be larger, as fewer or less complex referrals to female specialists could create a cycle, with lower skill accumulation and fewer opportunities to perform procedures.” Read: Just like the public-school system: Mandated rostering among the ideas heard in health-teams session Of the male-to-female differential in total annual payments from new referrals, close to 83% can be attributed to the differences in the number of referrals received, while just over 17% was due to a difference in the revenue per referral, the study found. Total billings for new initial referrals in the study were estimated at $1.4 billion, accounting for just over one-quarter of the total $5.3 billion in total fees-for-service paid for the 2018 to 2019 fiscal to the specialists in the data group. “The proportion of the differential accounted for by a difference in the revenue per referral was larger for surgical specialties (24%) compared with medical specialties (17.3%),” wrote the authors. “Stratifying referrals into the initial consult versus all subsequent encounters, we found almost no difference between medical and surgical specialties in the portion of the differential explained by revenue per referral for initial consultations (19% vs 17.8%, respectively). However, the portion accounted for by revenue per referral attributable to subsequent encounters was larger for surgical specialties (26.6%) compared with medical specialties (8.6%).” Citing another Ontario-based study that found surgical specialties with the highest proportion of women had the greatest referral inequities—with disparities persisting over time—the authors further concluded that equal representation of women in the medical profession “may be insufficient to eliminate gender-based referral bias.” Read: Feds warn Alberta clinic will violate medicare by charging for faster doctor access OMA president Dr. Andrew Park told the Medical Post the study should be a call for physicians to “examine our biases, to see where we have preconceived notions of individuals, genders or minorities and to ensure that we have a degree of equity in our profession.” The study findings also support a strong case for a centralized referral system designed to ensure primary care physicians send patients to specialists with the shortest wait times, according to an OMA news release. “Being transparent about individual specialists’ wait times may help female doctors who are thought to have shorter wait lists than men because of referral biases,” stated the release. “ As part of its proposals to improve the healthcare system, the OMA has already recommended creation of a centralized wait list and referral system in each of the six Ontario health regions for certain surgeries and procedures.” Of the total number of specialists included in the study data, 36% were female with a mean age of about 46 years while 64% were male with a mean age of about 52 years. The data group of referring physicians, in the meantime, was comprised 41% female with a mean age of just over 46 years and 59% male with a mean age of 53 years. “Compared with female specialists, male specialists were older, had more years of experience, and worked more days,” noted the researchers. “A higher percentage of female specialists had an academic status, worked part-time, had practices in large urban areas, and worked in hospital or office settings (versus a mixed setting) compared with male specialists.” Initial analysis found referring physicians had higher odds of referring to specialists of the same gender. But adjusted analysis also revealed higher odds of referring to male specialists, specialists with similar years of experience and specialists practising in the same hospital. Read: P.E.I.’s Virtual Hallway platform to see injection of specialists from Nova Scotia

Preferred and referred: New study shows male specialists are favoured by both male and female referring doctors

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