Gender bias can rear its head in unexpected ways. In a new study from Stanford researchers, female OB/GYNs were 47 percent less likely to receive top patient satisfaction scores than their male counterparts.

“I was surprised at just out big the gender bias is — much larger than I anticipated,” said lead author Carolyn Haunschild, MD. Haunschild presented these findings in a poster at the American Congress of Obstetricians and Gynecologists annual meeting in San Diego last week.

For their study, Haunschild and her colleagues looked at 909 Press-Ganey patient satisfaction surveys associated with visits to an outpatient gynecology clinic between March 2013 and June 2014. After considering other factors — like staff friendliness and clinic cleanliness and accessibility — that influence patients’ experiences, the researchers found that patients were more likely to say they’d recommend their OB/GYN if the doctor was male.

What makes these results all the more surprising is that this goes against patients’ stated preferences, suggesting that the gender bias is unconscious. Female patients typically request female doctors, especially in sensitive medical fields like urology and gynecology. Expectations of kindness and compassion from female doctors may explain why patients gravitate toward female OB/GYNs at first, Haunschild told me.

After the initial awkwardness passes, however, patients tend to prefer male doctors. And in situations where surgery is necessary, Haunschild said, many people request male surgeons, as male doctors are often perceived as more technically competent.

“It is important to keep in mind that this is also a surgical field,” said Haunschild, “and what people expect from surgeons is different” than what they expect from primary care. For example, patients tend to prefer surgeons who are confident and assertive. However, women with those traits are viewed less positively than men.

These results are especially timely, according to Haunschild, because there has been a recent push to incorporate quality of care metrics into health-care reimbursement. The authors advise using caution when interpreting patient-reported satisfaction information, as it is still unclear how unconscious bias can creep into surveys. “Gender bias can easily transfer into this process,” said Haunschild, “further entrenching gender bias in pay.”

In the medical field as a whole, salaries for female doctors are, on average, $20,000 less than their male counterparts. Within gynecology, Haunschild said the wage gap is about $36,000, and gender bias has the potential to further widen the divide.

“This is a great first study to raise awareness,” she said, “but the results can’t yet be generalized.”

The team’s next step is to expand upon this study to determine whether this pattern holds in larger patient groups and at different facilities. Eventually, the researchers hope the similar analyses can illuminate gender biases in other medical fields.

Previously: Stereotype perception linked to psychological health in female surgeons

Image by Scottish Resilience Development Service