Medicine has seen some profound changes in the last decades, especially with respect to gender. While traditionally a male-dominated field, recent years have seen women represent the majority of medical students in Canada (1), and family physicians under the age of 44 (2). The president-elect of the CMA is Dr. Gigi Osler (3), the first female surgeon to lead the CMA in its 150 years (4), but she’s also only the first female surgeon, and only the eighth female physician of any specialty. Yes we see female physicians deservedly winning awards but they are under-represented by a wide margin (5). Yes, we see female physicians in leadership positions all around us, excelling, yet only a small minority are in leadership positions both in our schools (6) and in our hospitals (7). So does medicine have a glass ceiling problem? Absolutely. Here, Google (8) it.
Are there other problems? Well, yes. Beyond the #metoomedicine movement (9) and income disparity (10), female doctors are judged more harshly – female surgeons are more likely to get fewer referrals from colleagues after an adverse event than male surgeons (11). Since we at ConsultLoop think of referrals every waking hour of the day (startup life being what it is), we had a question: Is this gender bias in referrals more pervasive? As in, is there a bias against referrals to female doctors, period?
As luck would have it, we have the ConsultLoop database of referrals and referral patterns mostly around the Greater Toronto Area. Looking at the last 15 000 referrals in our database, this includes referrals made to 1,951 specialists across 32 specialties. These specialists include those who are our clients, and those who are not. We initially built our specialist directory by calling nearly every doctor in most urban centres in Ontario, which should therefore be a reasonably representative sample of the full specialist population. Our directory grew organically through family doctors selecting a particular specialist or clinic as a destination of the referral, which should be relatively reflective of true family physician demand and referral patterns. Therefore, this sample of specialists and referrals to them is quite suitable for such an analysis.
We categorized all specialists as male, female or “neutral.” Neutral indicates that the referral destination was a hospital department rather than to any specific doctor. Our most frequent recipient of referrals is a client of ours. They are two male specialists who preferred to be listed as a clinic rather than individually, but we counted them as male. Let’s see how this breaks down:
We then looked at the total number of referrals to each gender category and divided that by the number of specialists in that category, to give us the average number of referrals that a specialist received in each category. Here, we would expect that male and female physicians average the same number of referrals. There may be a glass ceiling, but we surely are blind to gender when working with our colleagues.
Well, take a look at this:
We can see why “neutral” specialists, who are mostly hospital departments, are the most popular. A department may have a different type of demand, triage a different case mix, represent a group of doctors, and may also promise faster access to “next available” specialists. But are male doctors getting more referrals on average than female doctors? Male doctors averaged 7.67 referrals per doctor. Female doctors averaged 7.07. So yes. And if you take the ratio of the two:
And there you have it. Not only is there a glass ceiling in medicine, but women must navigate through bias that is pervasive even in the most germane of physician to physician interactions – the referral.
This is admittedly a back-of-the-envelope calculation, but it is an important finding. A bias in referrals has cascading effects on income inequality, career advancement in leadership within departments as well as medical associations, and the overall experience of female physicians as equals and partners within our medical system.
Join us on Twitter and follow us using #CLchats on Thursday, March 22nd at 8pm. We’ll be discussing some ways this bias has affected female doctors in their professional lives, and some ideas on how we can tangibly begin to create more equitable referral patterns.
(1): “Women outnumber men at most medical schools.” Maclean’s. http://www.macleans.ca/news/canada/how-many-get-in/
(2): Family Medicine Profile, CMA. https://www.cma.ca/Assets/assets-library/document/en/advocacy/Family-e.pdf
(3): “Dr. Gigi Osler elected the 2017 CMA president-elect nominee.” CMA.
(4): Comment: Access to health care is not a gender issue.” Times Colonist. http://www.timescolonist.com/opinion/columnists/comment-access-to-health-care-is-not-a-gender-issue-1.23128326
(5): Where Are the Women? The Underrepresentation of Women Physicians Among Recognition Award Recipients From Medical Specialty Societies. Silver, Julie K. et al. PM&R , Volume 9 , Issue 8 , 804 – 815. http://www.pmrjournal.org/article/S1934-1482(17)30660-3/fulltext
(6): Women are changing the face of medicine. CBC News. http://www.cbc.ca/news/health/women-are-changing-the-face-of-medicine-1.981567
(7): Promoting Female Leadership in Healthcare: An Interview with Dr. Lara Khoury, Co-Chair of the Female Physician Leadership Committee. UOJM. https://uottawa.scholarsportal.info/ojs/index.php/uojm-jmuo/article/view/2185/2003
(8): Search term: “Does medicine have a glass ceiling”. Google.ca. https://www.google.ca/search?q=does+medicine+have+a+glass+ceiling%3F&oq=does+medicine+have+a+glass+ceiling%3F&aqs=chrome..69i57.5039j0j7&sourceid=chrome&ie=UTF-8
(9): #metoomedicine. Twitter.com. https://twitter.com/search?q=%23Metoomedicine&src=tyah
(10): “Pay gap widens for women physicians; earnings average $105K less than men.” Fierce Healthcare. https://www.fiercehealthcare.com/practices/pay-gap-widens-women-physicians-doximity
(11): “Doctors judge female surgeons more harshly when patients die.” The Economist. https://www.economist.com/blogs/graphicdetail/2017/11/daily-chart-19