Sex Differences in the Pattern of Patient Referrals to Male and Female Surgeons

Abstract

IMPORTANCEStudies have found that female surgeons have fewer opportunities to perform highly remunerated operations, a circumstance that contributes to the sex-based pay gap in surgery. Procedures performed by surgeons are, in part, determined by the referrals they receive. In the US and Canada, most practicing physicians who provide referrals are men. Whether there are sex-based differences in surgical referrals is unknown. OBJECTIVE To examine whether physicians' referrals to surgeons are influenced by the sex of the referring physician and/or surgeon.

Benchmarking Surgeons’ Gender and Year of Medical School Graduation Associated With Monthly Operative Workdays for Multispecialty Groups

“…Our results from Florida show that such a large average difference between male and female surgeons calls for investigation of what might reflect systematic bias. The multispecialty group with three fewer days per month for female surgeons should seek to determine whether the difference reflects good flexibility of the organization (e.g., in meeting requests of women who want to work fewer days per month for personal or professional reasons) versus lack of responsiveness by the organization (e.g., fewer referrals of procedural patients to female surgeons as in Ontario [ 3 ], bias among department heads or other responsible leadership when apportioning their service’s allocated operating room time, the bias of female surgical schedulers and clinic nurses [ 12 ], and insufficient provision of administrative staff, nurse practitioners, and physician assistants).…”

“…(Genders listed in reference [ 2 ] are binary: “female” and “male.” Throughout our paper, we use “female” and “male” because those are the terms in the cited papers and are the only options in the data.) In November 2021, Dossa et al reported that throughout Ontario, female surgeons received fewer procedural referrals than male surgeons, principally because male physicians more often referred patients to male surgeons rather than female surgeons [ 3 ]. In this study, we used surgical cases statewide in Florida, categorized by surgeon and date of surgery, to compare operative days between female and male surgeons.…”

A Woman’s Place Is in Theatre, but Are Theatres Designed with Women in Mind? A Systematic Review of Ergonomics for Women in Surgery

“…Despite the fact that efforts to attract and retain the female surgical workforce are growing daily, these focus mainly on promoting a change in the culture [ 2 ], which has fortunately already resulted in a significant reduction in much of the overt sexism that was apparent in previous years. However, there remains an overarching theme where unconscious bias identifies surgeons to a stereotype of male individuals [ 3 ].…”

“…Why are diversity and inclusion (DEI)—i.e., the recognition that each individual requires different resources and opportunities to achieve an equal outcome—so important? In general, it is thought that people with different experiences, perspectives, and thinking styles combine and collaborate to create a stronger, more successful environment, so the inclusion of diverse surgical members ultimately builds better teams [ 3 , 4 ].…”

Improving Equity, Diversity, and Inclusion in Plastic, Reconstructive, and Aesthetic Surgery in Canada: A Call to Action

“…Additionally, female-identifying surgeons are more often referred cases that have less compensation 44 and overall receive fewer referrals from their male-identifying counterparts, sometimes related to persecutory practices not seen with male-to-male referrals. 45 Interestingly, recent literature suggests sex concordance among patients and surgeons may lead to better postoperative outcomes (eg, female patients treated by female surgeons, male patients treated by female surgeons). While female patients treated by male surgeons had worse outcomes (when compared to female patients treated by female surgeons), this effect was not seen with male patients treated by female surgeons (compared to male patients treated by male surgeons).…”