Abstract

BACKGROUND: Emerging data suggests patient satisfaction data is subject to inherent biases that negatively impact women physicians.OBJECTIVE: To describe the association between the Press Ganey patient satisfaction survey and physician gender in a multi-institutional study of outpatient gynecologic care.STUDY DESIGN: This was a multi-site, observational, population-based survey study using the results of Press Ganey patient satisfaction surveys from five unrelated community-based and academic medical institutions with outpatient gynecology visits between January 2020 - April 2022. The primary outcome variable was likelihood to recommend a physician and individual survey responses served as the unit of analysis. Patient demographic data was collected through the survey, including self-reported age, gender, and race/ethnicity (categorized as White, Asian, or Underrepresented in Medicine, which groups together Black, Hispanic/LatinX, American Indian or Alaskan Native, and Hawaiian or Pacific Islander). Bivariate comparisons between demographics (physician gender, patient and physician age quartile, patient and physician race) and likelihood to recommend were assessed using generalized estimating equation models clustered by physician. Odds ratios, 95% confidence intervals, and p-values for these analyses are reported and results were considered statistically significant at p<0.05. Analysis was performed using SAS (version 9.4, SAS Institute Inc., Cary, NC).RESULTS: Data were obtained from 15,184 surveys for 130 physicians, the majority were women (n=95, 73%) and White (n=98, 75%), and patients were also predominantly White (n=10,495, 69%). A little over half of all visits were race concordant, meaning both patient and physician reported the same race (57%). Women physicians were less likely to receive a topbox survey score (74% vs 77%) and in the multivariate model had 19% lower odds of receiving a topbox score (95% CI: 0.69 - 0.95). Patient age had a statistically significant relationship with score, with patients 63 and older having over a three-fold increase in odds of providing a topbox score (OR=3.10, 95% CI = 2.12 - 4.52) compared to the youngest patients. After adjustment, patient and physician race/ethnicity showed similar effects on the odds of a topbox likelihood to recommend score, with Asian physicians and Asian patients having lower odds of a topbox likelihood to recommend score when compared to White physicians and patients (OR=0.89, 95% CI = 0.81 - 0.98 and OR = 0.62, 95% CI = 0.48 - 0.79 respectively). Underrepresented in medicine physicians and patients showed significantly increased odds of a topbox likelihood to recommend score (OR=1.27, 95% CI = 1.21 - 1.33 and OR = 1.03, 95% CI = 1.01 - 1.06 respectively). Physician age quartile was not significantly associated with odds of a topbox likelihood to recommend score.CONCLUSIONS: Women gynecologists are 18% less likely to receive top patient satisfaction scores compared to men in this multi-site, population-based survey study using the results of Press Ganey patient satisfaction surveys. The results of these questionnaires should be adjusted for bias given they provide data currently being used to understand patient-centered care.

View details for DOI 10.1016/j.ajog.2023.06.023

View details for PubMedID 37330126