Effect of Resident Gender and Surname Origin on Clinical Load: Observational Cohort Study in an Internal Medicine Continuity Clinic

Abstract

Background: Studies show patients may have gender or racial preferences for physicians. Objective: To determine the degree to which physicians’ gender and name characteristics influenced physician clinical load in medical practice, including patient panel size and percent of slots filled. Design: Observational cohort study of a continuity clinic site in Rochester, MN, from July 1, 2015 to June 30, 2017 (“historical” period) and July 1, 2018 to January 30, 2020 (“contemporary” period). Participants: Internal medicine resident physicians. Main Measures: Resident gender, name, and race came from residency management system data. Panel size, percent of appointment slots filled (“slot fill”), panel percent female, and panel percent non-White came from the electronic health record. Multivariable linear regression models calculated beta estimates with 95% confidence intervals and R2 for the impact of physician gender, surname origin, name character length, and name consonant-to-vowel ratio on each outcome, adjusting for race and year of residency. Key Results: Of the 307 internal medicine residents, 122 (40%) were female and 197 (64%) were White. Their patient panels were 51% female (SD 16) and 74% White (SD 6). Female gender was associated with a 5.3 (95% CI 2.7–7.9) patient increase in panel size and a 1.5% (95% CI −0.6 to 3.7) increase in slot fill. European, non-Hispanic surname was associated with a 5.3 (95% CI 2.6–7.9) patient increase in panel size and a 4.3 percent (95% CI 2.1–6.4) increase in slot fill. Race and other name characteristics were not associated with physician clinical load. From the historical to contemporary period, the influence of name characteristics decreased from 9 to 4% for panel size and from 15 to 5% for slot fill. Conclusions: Female gender and European, non-Hispanic surname origin are associated with increased physician clinical load—even more than race. While these disparities may have serious consequences, they are also addressable.