How Second Opinions Cost Female Physicians Big Money

By Manasvini Singh, PHD
July 12, 2022

This week’s contributor is Manasvini Singh, an Assistant Professor of Health Economics at the University of Massachusetts Amherst. Her interests lie at the intersection of applied decision theory and health policy, particularly in how physicians make decisions, how organizational and policy environments affect such decisions, and its implications for patient welfare.

Several studies have shown that female physicians earn less than male physicians. Possible explanations include the “child penalty” (working mothers getting lower pay, being viewed as less competent, and receiving fewer benefits relative to childless women) and women choosing to enter lower-paying specialties.

A new study in American Sociology Review provides evidence on another potential reason: male patients’ lower trust in female physicians’ expertise. To look at this issue, Mathijs de Vaan and Toby Stuart analyzed 1.9 million office visits to medical specialists in Massachusetts where patients were seeking a second opinion. 

Their study found:

  • Compared to female patients, male patients were more likely to seek a second opinion if the first physician they saw was female.
  • When male patients sought second opinions, it was more likely to be from a male physician, and they tended to keep seeing that male physician for the rest of their care. 
  • As a result, female specialists earned about 11% less than their male counterparts.

The findings don’t explain why patients sought more male doctors for second opinions, but the authors theorize it could be because it is difficult for patients to assess the objective quality of a medical recommendation, making it more likely that other factors (like their physician’s gender) will influence their decision-making. Other research shows even physicians themselves resort to gender as a marker of expertise when referring patients to specialists.

The study’s biggest limitation is that patients weren’t randomly assigned to their first doctor, which makes it harder to draw conclusions about how often people sought second opinions. But these results are still an important addition to the conversation over the gender pay gap among physicians. Lower compensation could reduce the number of female physicians in the workforce, and even lead to worse outcomes for all patients. There is a growing recognition that when a patient has a physician who shares the same gender, race or other sociodemographic status, it can improve their health — potentially through increased trust, better communication and a greater overlap in life experiences.

This underscores the importance of having a representative physician workforce, and with the U.S. healthcare system facing historic levels of provider burnout and turnover, any reduction in the physician workforce could have outsized consequences for patient health.

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