Madanay Farrah, Bundorf M Kate, Ubel Peter A
Sanford School of Public Policy, Duke University, Durham, North Carolina.
Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor.
JAMA Netw Open. 2025 Feb 3;8(2):e2460018. doi: 10.1001/jamanetworkopen.2024.60018.
Prior studies have revealed gender differences in workplace assessments of physicians, but little is known about differences by physician gender in patients' online written reviews.
To analyze whether patients' perceptions of their physicians' interpersonal manner and technical competence differ by physician gender and practicing specialty and are associated with review star ratings.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study sampled written reviews submitted by patients between October 16, 2015, and May 27, 2020, for physicians across the US from a commercial physician rating and review website. Physicians included primary care physicians (PCPs) listed under family medicine, internal medicine, and pediatrics and surgeons listed under general surgery; orthopedic surgery; and cosmetic, plastic, and reconstructive surgery. Hand-coded reviews were used to fine-tune a natural language processing algorithm to classify all reviews for the presence and valence of patients' comments of physicians' interpersonal manner and technical competence. Statistical analyses were performed from July 2022 to December 2024.
Female or male physician gender.
Outcomes included the presence and valence of interpersonal manner and technical competence comments and receipt of high star ratings. Multilevel logistic regressions analyzed differences by female or male physician gender in interpersonal manner and technical competence comments and whether those comments were associated with review star ratings.
The analysis included 345 053 written reviews of 167 150 physicians (mean [SD] age, 55.16 [11.40] years); 60 060 physicians (35.9%) were female, and 36 132 (21.6%) were surgeons. Female physicians overall had higher odds than males of receiving any (odds ratio [OR], 1.19; 95% CI, 1.16-1.22) or negative (OR, 1.22; 95% CI, 1.18-1.26) patient comments for their interpersonal manner. Among PCPs, females had higher odds than males of receiving a negative comment for interpersonal manner (OR, 1.22; 95% CI, 1.18-1.27) and, when receiving that negative comment, had disproportionately lower odds of receiving a high star rating (OR, 0.62; 95% CI, 0.53-0.73). Female physicians overall (OR, 1.09; 95% CI, 1.05-1.13) and female PCPs (OR, 1.08; 95% CI, 1.04-1.13) had higher odds than their male counterparts of receiving a negative comment for their technical competence. When receiving a negative comment for technical competence, both female PCPs (OR, 0.60; 95% CI, 0.50-0.73) and female surgeons (OR, 0.67; 95% CI, 0.50-0.89) had disproportionately lower odds of receiving a high star rating compared with their male counterparts. Female PCPs also had lower odds than male PCPs of receiving a high star rating when receiving a positive comment for technical competence (OR, 0.82; 95% CI, 0.70-0.96).
In this cross-sectional study of online written reviews, female and male physician gender were differently associated with patients' perceptions of their physicians' interpersonal manner and technical competence. The findings suggest that patients harbored negative gender biases about the interpersonal manner of female physicians, especially female PCPs, and also assessed disproportionate penalties related to technical competence for both female PCPs and female surgeons.
先前的研究揭示了职场中对医生评估的性别差异，但对于患者在线书面评价中医生性别的差异了解甚少。
分析患者对医生人际态度和技术能力的看法是否因医生性别和执业专科不同而存在差异，以及这些看法与评价星级之间的关联。
设计、设置和参与者：这项横断面研究对2015年10月16日至2020年5月27日期间美国患者从一个商业医生评级和评价网站提交的针对医生的书面评价进行了抽样。医生包括家庭医学、内科和儿科列出的初级保健医生（PCP）以及普通外科、整形外科、骨科手术和美容、整形与重建外科列出的外科医生。人工编码的评价用于微调自然语言处理算法，以对所有评价中患者对医生人际态度和技术能力的评论的存在情况和效价进行分类。统计分析于2022年7月至2024年12月进行。
医生的性别为女性或男性。
结局包括人际态度和技术能力评论的存在情况和效价以及获得高星级评价。多水平逻辑回归分析了女性或男性医生在人际态度和技术能力评论方面的差异，以及这些评论是否与评价星级相关。
分析纳入了167150名医生的345053条书面评价（平均[标准差]年龄，55.16[11.40]岁）；60060名医生（35.9%）为女性，36132名（21.6%）为外科医生。总体而言，女性医生比男性医生更有可能收到关于其人际态度的任何（优势比[OR]，1.19；95%置信区间，1.16 - 1.22）或负面（OR，1.22；95%置信区间，1.18 - 1.26）患者评论。在初级保健医生中，女性比男性更有可能收到关于人际态度的负面评论（OR，1.22；95%置信区间，1.18 - 1.27），并且在收到该负面评论时，获得高星级评价的可能性显著较低（OR，0.62；95%置信区间，0.53 - 0.73）。总体而言，女性医生（OR，1.09；95%置信区间，1.05 - 1.13）和女性初级保健医生（OR，1.08；95%置信区间，1.04 - 1.13）比男性同行更有可能收到关于其技术能力的负面评论。当收到关于技术能力的负面评论时，女性初级保健医生（OR，0.60；95%置信区间，0.50 - 0.73）和女性外科医生（OR，0.67；95%置信区间，0.50 - 0.89）与男性同行相比，获得高星级评价的可能性显著较低。当收到关于技术能力的正面评论时，女性初级保健医生获得高星级评价的可能性也比男性初级保健医生低（OR，0.82；95%置信区间，0.70 - 0.96）。
在这项关于在线书面评价的横断面研究中，女性和男性医生在患者对其人际态度和技术能力的看法方面存在不同关联。研究结果表明，患者对女性医生，尤其是女性初级保健医生的人际态度存在负面性别偏见，并且对女性初级保健医生和女性外科医生的技术能力评估也存在不成比例的惩罚。
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