Exploring Gender Bias in Health Care

JULY 06, 2019
Patrick Campbell
doctor and patientA recent study has dove further into the discussion of gender bias among health care professionals and surgeons.

Using the Implicit Association Test (IAT), investigators found that respondents had a tendency to associate men with career and surgery and women with family and family medicine.

In order to determine whether surgeons and health care professionals held implicit or explicit biases regarding gender and career roles, investigators reviewed 42,991 IAT records and a cross sectional study of 131 surgeons. The data review and study collected data from Jan. 1, 2006 through Dec. 31, 2017.

Of the 42,991 responses to the Gender-Career IAT, which was hosted by Project Implicit, investigators found the respondents to be consistent with the health care workforce as a whole. Of the respondents, 82% were women, mean age was 32.7 years and 69.2% of participants were white. About one-third (33.5%) were nursing and home health care assistants, 24.9% were diagnosing and treating professionals. Data from 910,887 non-health care professionals were available as well. 

After analyses, investigators found that healthcare professionals held both implicit (mean [SD], 0.41 [0.36]; Cohen d = 1.14) and explicit (1.43 [1.85]; Cohen d = 0.77) biases associating men with career and women with family. Investigators found similar results among surgeons as they implicit and explicit associated men with the surgery field and women with family medicine. 

Additionally, investigators found broader evidence of consensus across social groups in implicit and explicit biases with one noted exception. Women in healthcare (mean , 1.43 [1.86]; Cohen d = 0.77) and surgery (0.73 [0.35]; Cohen d = 0.53) were less likely than men to explicitly associate men with career (B coefficient, −0.10; 95% CI, −0.15 to −0.04; P < .001) and surgery (B coefficient, −0.67; 95% CI, −1.21 to −0.13; P = .001) and women with family and medicine. 

Investigators noted limitations within their study. For example, the study lacked granularity about health care fields from Gender-Career IAT data and investigators were unable to isolate physicians exclusively. The category of diagnosis and treating professionals may include other professionals including dentists, nurse practitioners and physician assistants. The study also appears to have under sampled older surgeons.

Within their conclusion, investigators wrote that this work should serve as an initial estimate of the extent of bias within health care. Investigators called for further research of implicit associations and that awareness of these biases is the first step to minimizing their impact. 

In an invited commentary, Fahima Dossa, MD, and Nancy Baxter, MD, PhD, both of the University of Toronto, wrote that the results can serve as a starting point in attempting to eliminate and change biased behavior among the medical profession.

“Knowledge of these biases will not automatically translate into behavior change. A starting point for change may be acknowledging that we all carry these biases and considering how they may be affecting our perception of reality,” Dossa and Baxter wrote.   “By understanding how our interpretation of situations varies based on the biases we carry, we can attempt to predict how these biased interpretations might affect our behaviors and identify tangible strategies to mitigate the effects of implicit bias.”

This study, titled “Estimating Implicit and Explicit Gender Bias Among Health Care Professionals and Surgeons,” is published in JAMA Network Open. 

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