Gender Differences in Medical Examinations
There is growing evidence of gender disparities in health care settings, where female patients receive less health care than male patients with similar medical conditions and are more likely to be told by providers that their symptoms are emotionally driven rather than arising from a physical impairment. Differences in doctors’ evaluations of medical issues for male and female patients may be a key factor contributing to observed differences in treatment.
Medical evaluations also impact benefit eligibility in social insurance programs. A recent study finds that female applicants for Social Security Disability Insurance are 20 percentage points more likely to be rejected than similar male applicants. Yet there is little evidence on what drives these disparities and what policies may affect them.
The gender of doctors could play a role in medical evaluations if patients and providers having similar characteristics and backgrounds improves provider-patient communication or reduces provider bias against a patient or the types of health issues that the patient is likely to have. However, studying the role of provider gender in medical evaluations is difficult because both patients and doctors can influence doctor-patient matches.
In Gender Differences in Medical Evaluations: Evidence from Randomly Assigned Doctors (NBER RDRC Working Paper NB21-20), researchers Marika Cabral and Marcus Dillender leverage the random assignment of doctors to patients within the Texas workers’ compensation insurance system.
Medical evaluations are performed by randomly assigned doctors when there is a dispute over an injured worker’s impairment level, which occurs in over one-third of workers’ compensation claims with cash benefits. The authors compare the impact of being randomly assigned a female doctor rather than a male doctor on the subsequent receipt of benefits for female claimants to the analogous impact of doctor gender on the outcomes of male claimants. They use linked administrative data covering all medical bills and cash benefits paid for workers’ compensation claims in Texas as well as information on medical evaluations performed by doctors randomly assigned through the dispute resolution system.
The results indicate that doctor-patient gender match increases evaluated disability and subsequent cash disability benefit receipt for female patients but has little impact on the outcomes of male patients. When female and male claimants are assessed by male doctors, female claimants are 3.1 percentage points less likely to be assessed as having a continuing disability. Female patients randomly assigned a female doctor rather than a male doctor are 3.0 percentage points (or 5.0 percent) more likely to be evaluated as having an ongoing disability relative to the difference among their male patient counterparts. Thus, assignment to a female doctor almost completely closes the gender gap that exists when male doctors are the evaluators.
Female patients randomly assigned a female doctor rather than a male doctor receive 8.5 percent more cash benefits on average, or $478 relative to the mean of $5,626. This represents a 61 percent closure of the gender gap in cash benefits observed when male doctors evaluate patients. There is no analogous gender-match effect for male patients.
The authors also present evidence from a survey they conducted that suggests that differences in doctor behavior may be an important mechanism for gender differences in medical evaluation. Women are more likely than men to report having a negative experience with a doctor and more likely to say that having an own-gender doctor would result in an improved patient experience.
In concluding, the authors state, “The findings indicate that being evaluated by a female doctor (relative to a male doctor) improves outcomes for female claimants and reduces gender gaps in outcomes relative to those observed when evaluations are conducted by male doctors.… Overall, the estimates indicate that the gender of the evaluating doctor is an important determinant of gender gaps in this setting, and the underrepresentation of females among doctors is likely a major explanation behind observed gender gaps in these outcomes.” They conclude that policies to increase the share of female doctors and increase doctor-patient gender matches “may have substantial impacts and complement one another in closing gender gaps in evaluated disability.”
The research reported herein was performed pursuant to grant RDR18000003 from the US Social Security Administration (SSA) funded as part of the Retirement and Disability Research Consortium. The opinions and conclusions expressed are solely those of the author(s) and do not represent the opinions or policy of SSA, any agency of the Federal Government, or NBER. Neither the United States Government nor any agency thereof, nor any of their employees, makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of the contents of this report. Reference herein to any specific commercial product, process or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement, recommendation or favoring by the United States Government or any agency thereof.
