Take action to address endemic gender disparity in patient referrals
Female surgeons are at a disadvantage: they receive less referrals, especially, operative referrals and earn less even after controlling for lifestyle and experience.
… and the disparity is not getting better over time or as more women enter surgery!
Inequitable patient referrals due to unfounded gender bias
Our Solution: An intelligent Central Intake that balances referrals
Clinnect offers a central patient intake solution (pooled patient referrals) that immediately closes the gender disparity gap. Patient referral volumes are distributed equitably in your group based upon rules you set including the option to see the ‘next available surgeon’.
Equitable distribution of referrals with a central patient intake
Do you want to address gender disparity head on?
You have two options:
(a) implement a Clinnect central intake
(b) consolidate your group’s clinical records and practice onto a single EMR system
Choose option (a) if you want to take the easy route and don’t mind spending an additional $90/month.
Choose option (b) if you want to share clinical records and can commit to the expense, time and headache of consolidating your office EMR systems.
| Comparison of Central Patient Intake Systems |
Clinnect |
Consolidated EMR |
|---|---|---|
| Ability to implement referral standards for the group | ✓ | ✓ |
| Improved patient access | Reduced wait times to consultation | ✓ | ✓ |
| Address surgeon gender disparity | ✓ | ✓ |
| Screen for duplicate patients and incomplete referrals | ✓ | ✓ |
| Integrated central intake fax number | ✓ | ✓ |
| Automated triage based upon rules set by your group | ✓ | ✗ |
| Unable to “game” patient triage | ✓ | ✗ |
| Triage audit history | ✓ | ✗ |
| Eliminate referral “cherry picking”
e.g. low comorbidity or high billing fees |
✓ | ✗ |
| Ability to equitably distribute referrals amongst parttime and fulltime doctors | ✓ | ✗ |
| Automatically include or exclude subspeciality case mix in your individual practice | ✓ | ✗ |
| Retain confidential patient records individually | ✓ | ✓ Option to share patient records |
| Setup and live in two weeks with 2 hours of training | ✓ | ✗ Months of time and effort to implement |
| Basic reports | ✓ | ✓ |
| Advanced reports for referral distribution, triage calibration and performance | ✓ | ✗ |
Gender Bias in Patient Referrals
The medical system in Canada has a fundamental flaw that we can’t seem to escape. It affects patient care, wait times, and impacts the services provided by surgeons. Even with the gender gap closing in medical school (source), and more women entering the medical field than ever before, subconscious gender bias still affects the lives and practices of female surgeons.
An Ontario study of 39.7 million referrals over 20 years recently published in the American Medical Association’s journal, compared referrals to male and female surgeons. The results expose the saddening truth that male physicians refer to male surgeons more frequently than to female surgeons, and that the situation is not improving over time (source). The study found that male surgeons had a 32% greater chance of receiving referrals from male physicians, whereas female surgeons had a 1.6% greater chance of receiving referrals from female physicians.
This study is not unique; rather it is part of an ever growing body of evidence highlighting the gender bias in medicine. A 4-year study examined pay-per-service funding found that female surgeons earned 24% less per hour than their male colleagues (source). The pay gap was not caused by a difference in hours worked between male and female surgeons. Nor was the pay gap explained by gender differences in time spent operating for the same procedure. The findings suggest that the gender pay gap is caused by male surgeons receiving more lucrative patient referrals than female surgeons.
Surgeons train to perform surgery and gender disparity exists even in this core ethos. The Ontario study found that 25% of referrals to female surgeons were procedural, compared to 33% to male surgeons (source). Yet another study identified that the pay gap still exists even after controlling for physician age, specialty, hours worked and practice characteristics (source).
These disparities show the subconscious belief that female surgeons are less competent and less trustworthy than male surgeons. The bias is caused by the compounding effect of gender bias throughout medical school, residency, male-dominated leadership, hiring and promotion decisions, and referring bias (source). These unfounded beliefs need to, and can be addressed by a central patient intake system that fairly utilizes female talent and time.
Over the next few years, as more and more women enter the field of medicine, the gender bias will only continue to hamper patients access to care and the quality of work life for female doctors while their expertise is underutilized. The time to end the effects of gender bias in referring is now.
References
Dossa F, Zeltzer D, Sutradhar R, Simpson A, Baxter N. | Sex Differences in the Pattern of Patient Referrals to Male and Female Surgeons.
PMID. 2021;157(2):95-103. doi:10.1001/jamasurg.2021.5784
Dossa F, Simpson AN, Sutradhar R, et al. | Sex-based disparities in the hourly earnings of surgeons in the fee-for-service system in Ontario, Canada.
JAMA Surg. 2019;154(12):1134-1142. doi:10.1001/jamasurg.2019.3769
Cohen M, & Kiran T. | Closing the gender pay gap in Canadian medicine.
CMAJ. 2020;192(31):1011-7. doi:10.1503/cmaj.200375
Burton K, & Wong I. | A force to contend with: The gender gap closes in Canadian medical schools.
CMAJ. 2004;170(9):1385-1386. doi:10.1503/cmaj.1040354
Additional References and Readings
Variation in patient-sharing networks of physicians across the United States.
Journal of the American Medical Association. 2012
Gender pay gap in England’s NHS: little progress since last year.
British Medical Journal. 2019
Income inequality among general practitioners in Iran: a decomposition approach.
BioMed Central Health. 2019
What determines the income gap between French male and female GPs—the role of medical practices.
BioMed Central Family Practice. 2012
Sex differences in physician salary in US public medical schools.
Journal of the American Medical Association. 2016
What explains wage differences between male and female Brazilian physicians? A cross-sectional nationwide study.
British Medical Journal Open. 2014
Gender differences in job quality and job satisfaction among doctors in rural western China.
BioMed Central Health. 2017
Higher income for male physicians: findings about salary differences between male and female Iranian physicians.
Balkan Medical Journal. 2019
Trends in the earnings of male and female health care professionals in the United States, 1987 to 2010.
Journal of the American Medical Association. 2013
Gender differences in the salaries of physician researchers.
Journal of the American Medical Association. 2012
The gender pay gap for doctors is getting worse. Here’s what women make compared to men.
Time. 2019
Why are women still earning less than men in medicine?
Canadian Medical Association Journal. 2018
Why is there a gender wage gap in Canadian medicine?
HealthyDebate. 2018
Practice patterns and work environments that influence gender inequality among academic surgeons.
The American Journal of Surgery. 2019
Geographic variations in physician relationships over time: implications for Care Coordination.
SAGE Journal. 2017
Variation in patient-sharing networks of physicians across the United States.
Journal of the American Medical Association. 2012
We have examined hundreds of surgeons’ practices.
Contact us to discuss if Clinnect is right for you!
info@clinnect.ca
250-319-8039