Lund, Jon D. MD*; Rohrer, James E. PhD†; Goldfarb, Susana CNP*
From the *Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, California; and †Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Amarillo, Texas.
The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.
Reprints are not available. Address correspondence to: Jon D. Lund, c/o Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center Amarillo, Amarillo, TX 79106; e-mail: firstname.lastname@example.org.
Received June 28, 2004. Received in revised form October 24, 2004. Accepted November 18, 2004.
OBJECTIVE: To quantify preferences for female providers among obstetric–gynecology patients in a large military teaching hospital in California.
METHODS: A questionnaire regarding patient preferences for female provider was distributed to and collected from 1,544 obstetric–gynecology patients over a two-month period. Responses were tabulated overall and for several demographic subgroups.
RESULTS: Sixty percent of respondents indicated they had no provider gender preference or they preferred a male. Significant ethnic preferences were noted among Asian, Pacific Islander, and Native-American women. Junior officers, wives, and daughters of service members also showed a greater preference for a female physician provider.
CONCLUSION: The majority of obstetric–gynecology patients surveyed had no strong preferences for female providers. In the interest of patient satisfaction, where strong gender preferences exist, attempts to accommodate could be made without overburdening female staff.
LEVEL OF EVIDENCE: III
As military hospitals compete with the private sector in caring for retired and active duty military members and their families, issues of patient preferences and perceptions assume increasing importance. With the gender shift in obstetric–gynecology physicians over the past several years, the increasing availability of female physicians has allowed greater patient choice. While attempts to accommodate patient preferences are usually made, staffing limitations do exist, and if strong preferences are involved, the issue could be a significant source of patient dissatisfaction.
Studies over the past 4 years have shown a preference for female obstetric–gynecology physicians ranging from 34% to 61%. Represented in these studies are results from New Zealand health clinics,1 university-based medical centers in Illinois and Connecticut,2–4 community hospitals in Brooklyn, New York,5 and hospital-based clinics in Halifax, Nova Scotia.6 The only other study of this kind in a military hospital showed a female provider preference rate of 52%.7
This survey was undertaken to quantify the incidence of obstetric–gynecology provider gender preferences among our military hospital and clinic patients and thereby provide pertinent data for clinic and hospital planning. At the time of the study the clinic staffing was equally represented by female and male physicians, but all nurse practitioners and midwives were female.
MATERIALS AND METHODS
Over a 2-month period, a total of 1,544 women receiving obstetric–gynecology services at a large military hospital completed a 2-page questionnaire relating to patient preferences and priorities. The primary focus of the survey was to evaluate patient preferences regarding physician-provider gender. The survey was approved by the Institutional Review Board; no written consents were required.
The questionnaire was formatted on a 2-sided standard automated data form; they were distributed to patients receiving obstetric–gynecology care at all department clinics, as well as to antepartum and postpartum inpatients. With receipt of the survey, each patient also received written and verbal explanations and instructions from clinic staff. Patients previously completing a questionnaire at any location were excluded from repeat sampling.
Two-way tables were used to test association between each independent variable and the dependent variable (Do you prefer a particular gender?). Univariate χ2 tests were used to test for an association. Those variables that were associated with preference at P < .10 were combined into a multiple logistic regression model to test for an independent relationship with preference.
A diverse patient population is represented in the 1,544 patients responding to this survey (Table 1). Seventy percent of respondents were aged 20–39 years, and for 80% of them, they or their family members were on active duty. Fifty-one percent were white with similar distributions of Asians (14%), African-Americans (15%), and Hispanics (14%). The rank distribution was junior enlisted (29%), middle and upper enlisted (52%), junior officer (8%) and middle and upper officer (11%). Seventy-three percent were wives and 3% daughters of service members, whereas 24% were active duty members.
Sixty percent of the respondents indicated that they had no particular gender preference or they preferred a male physician-provider, whereas forty percent preferred a female (Table 2). Associated with gender preference at P < .10 were age, race, rank, and duty status (Table 3). Multiple logistic regression analysis (Table 4) revealed an independent association between gender preference and 3 race categories, each compared against African American: Asian (adjusted odds ratio [AOR] = 2.6), Pacific Islander (AOR = 1.03), and Native American (AOR = 2.8). Junior Officers had greater odds of having a gender preference relative to enlisted members in the ranks E1-E4 (AOR = 1.7). Relative to patients who were in the service themselves, wives and daughters had greater odds of having a gender preference (AOR = 1.35 and AOR = 3.34, respectively).
The findings of this study should be treated with a degree of caution because the sample was drawn from a single military facility and may not be generalized to other bases or the civilian population. In addition, the results might be sensitive to other variables not included or only inferred, such as educational levels or income. Despite these limitations, we believe the results have some potentially important implications.
First, we note that our study is unique because of the large sample size and the heterogeneity of racial distribution. We observed that in our population 60% of obstetric–gynecology patients surveyed had no preference for a female provider. The only other military hospital survey we found was done by Chandler et al7 in 2000, which showed 48% of their patients with no gender preference or preferring a male obstetric–gynecology provider. The small sample size (N = 203) and limited racial diversity (87% white or African-American) in that study may explain the variance from our results.
Second, it is important to note that Asians, Pacific Islanders, and Native Americans were more likely to have a gender preference than African Americans. Although limited in number, Chandler's results support our findings that Asian women have a significant preference for female obstetric–gynecology providers. Another study involving Pacific-Islanders in New Zealand did not confirm our results for a significant preference in this ethnic group.1 The results of our findings among the above cultural groups need to be verified. If they are confirmed to be generally true then obstetric–gynecology clinics should be sensitive to the possibility that some of these cultural groups will be more comfortable with female providers.
There is also a noted gender preference among junior officers, suggesting that younger and more educated patients may be more comfortable with a female obstetric–gynecology provider. Whether these findings are transient among this group or whether they reflect a greater trend toward female obstetric–gynecology providers is unknown. Others have shown that being highly educated is associated with an increased female provider preference.8
Finally, we note that wives and daughters of service members are more likely to have a gender preference than military members themselves. As dependents of service members, the requests of these groups of women should be honored whenever possible. The corresponding lack of preference among active duty service members may have several explanations. One possibility is that a perceived lack of choice exists among active duty service members, particularly in the junior enlisted ranks. There is also the possibility of preexisting military selection biases or a modification of preferences after enlistment.
A MEDLINE literature search (keywords: “patient,” “physician,” “provider gender preferences”; 1980–2005) indicates that this study is the second largest sampling of obstetric–gynecology patient provider gender preferences overall and the largest assessment of this patient concern in a military clinic and hospital to date. We have demonstrated that 60% of our patients have no preference or they prefer a male provider. Our findings may apply in other clinic and hospital settings to the degree that the corresponding population demographics exist.
Our study would seem to have significance for clinic and hospital planners and schedulers. The results can be used to help identify subgroups of patients with higher female preference rates in an attempt to optimize patient satisfaction. Knowing which patients are most likely to have a preference should assist providers in their effort to provide patient-centered care, whenever possible, by respecting patient choices. By being aware of potential patient concerns, clinic staff would also have an opportunity to promote gender neutrality in physician selection while being sensitive to those patients with strong preferences.
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