Adrianna McIntyre is an assistant professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health. Her research focuses on the politics of health reform and barriers to take-up and retention of social program benefits. Adrianna is a member of the 2022 Tradeoffs Research Council.

Multiple recent papers suggest female patients receive better care from female physicians. But it’s difficult to show that this gender match directly leads to better care. What if female patients who sought out female physicians were also more active participants in their own care, and that’s why they had better outcomes? A new NBER working paper moves us closer to untangling the answers to this tricky question.

Researchers Marika Cabral and Marcus Dillender looked at what happened when people were randomly assigned to doctors to see if an injury qualified them for disability benefits through workers’ compensation. They found that female patients assigned a female doctor were 5% more likely to be evaluated as having a disability and received an extra $478 in workers’ compensation benefits on average — 8.5% more than female patients assigned to male doctors. But they found no such imbalance for male patients — male and female doctors evaluated them consistently. This was strictly a problem for female patients. 

The authors tried to see if the difference could be explained by other patient characteristics — like age, pre-injury income or industry risk level — or other doctor characteristics — like age, type of doctor or birthplace. But none of it mattered. As the authors put it, “…there is something fundamental or essential about gender” driving these disparities.

There were some limits on the data the authors used. They couldn’t explain why female patients were better off being examined by a female doctor; they couldn’t distinguish between gender identity and sex assigned at birth; and the data did not appear to include identifiers for race or ethnicity. A number of studies suggest that race concordance between patients and doctors also matters for health care outcomes.

And while this paper’s findings center on workers’ compensation, they have major implications throughout the health care system and social safety net. For example, just like doctors can decide if someone gets workers’ compensation benefits, they can also decide whether to refer a patient to a specialist for additional care.

An obvious solution is to increase the number of female doctors. But even though women now make up half of all medical students, nearly two-thirds of active doctors are men — suggesting there’s not a quick fix to this problem. But this paper makes it clear that this imbalance can have real consequences for female patients, so finding a solution, while not easy, is urgently necessary.