Effect of physician gender and race on simulated patients’ ratings and confidence in their physicians : A randomized controlled trial

Journal article


Solnick, Rachel E., Peyton, Kyle, Kraft-Todd, Gordon and Safdar, Basmah. (2020). Effect of physician gender and race on simulated patients’ ratings and confidence in their physicians : A randomized controlled trial. JAMA Network Open. 3(2), p. e1920511. https://doi.org/10.1001/jamanetworkopen.2019.20511
AuthorsSolnick, Rachel E., Peyton, Kyle, Kraft-Todd, Gordon and Safdar, Basmah
Abstract

Importance Women and black physicians encounter workplace challenges because of their gender and race. It is unclear whether these individuals are assessed with lower patient satisfaction or confidence ratings compared with white male physicians.

Objective To examine whether physician gender and race affect participant ratings in scenarios in which physician competence is challenged.

Design, Setting, and Participants This randomized trial enrolled a geographically diverse sample of 3592 online respondents in the United States who were recruited from 2 crowdsourcing platforms: Amazon Mechanical Turk (n = 1741) and Lucid (n = 1851). A 2 × 2 factorial design for the gender and race of simulated physicians was conducted between March 9 and July 25, 2018. Participants were excluded before intervention if they were younger than 18 years, were pregnant, or had a history of cancer or abdominal surgical procedures.

Interventions A clinical vignette was presented to the participant with a picture of the emergency department physician. Participants were randomly assigned to physicians with different gender and race, with 823 assigned to black women, 791 to black men, 828 to white women, and 835 to white men. A contradictory diagnosis from an online symptom checker introduced doubt about the clinical diagnosis.

Main Outcomes and Measures A composite outcome (range, 0-100, with 0 representing low patient confidence and satisfaction and 100 representing the maximum on the composite scale) measured participant (1) confidence in the physician, (2) satisfaction with care, (3) likelihood to recommend the physician, (4) trust in the physician’s diagnosis, and (5) likelihood to request additional tests.

Results Among 3277 adult participants, complete data were available for 3215 (median age, 49 years [range, 18-89 years]; 1667 [52%] female; 2433 [76%] white). No significant differences were observed in participant satisfaction and physician confidence for the white male physician control physicians (mean composite score, 66.13 [95% CI, 64.76-67.51]) compared with white female (mean composite score, 66.50 [95% CI, 65.19-67.82]), black female (mean composite score, 67.36 [95% CI, 66.03-68.69]), and black male (mean composite score, 66.96 [95% CI, 65.55-68.36]) physicians. Machine learning with bayesian additive regression trees revealed no evidence of treatment effect heterogeneity as a function of participants’ race, gender, racial prejudice, or sexism.

Conclusions and Relevance No significant differences were observed for simulated patients’ evaluations of female or black physicians, suggesting that bias in favor of white male physicians is negligible in survey-based measures of patient satisfaction.

Year2020
JournalJAMA Network Open
Journal citation3 (2), p. e1920511
PublisherAmerican Medical Association
ISSN2574-3805
Digital Object Identifier (DOI)https://doi.org/10.1001/jamanetworkopen.2019.20511
Scopus EID2-s2.0-85080849199
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-15
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online21 Feb 2021
Publication process dates
Accepted20 Nov 2019
Deposited03 Jul 2021
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https://acuresearchbank.acu.edu.au/item/8w4z3/effect-of-physician-gender-and-race-on-simulated-patients-ratings-and-confidence-in-their-physicians-a-randomized-controlled-trial

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License: CC BY 4.0
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