Effect of Physician Gender and Race on Simulated Patients’ Ratings and Confidence in Their Physicians: A Randomized Trial | Emergency Medicine | JAMA Network Open | JAMA Network
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    Original Investigation
    Health Policy
    February 21, 2020

    Effect of Physician Gender and Race on Simulated Patients’ Ratings and Confidence in Their Physicians: A Randomized Trial

    Author Affiliations
    • 1National Clinical Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
    • 2Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor
    • 3Yale Law School, New Haven, Connecticut
    • 4Department of Psychology, Boston College, Chestnut Hill, Massachusetts
    • 5Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
    JAMA Netw Open. 2020;3(2):e1920511. doi:10.1001/jamanetworkopen.2019.20511
    Key Points español 中文 (chinese)

    Question  In a simulated clinical encounter, do participants evaluate physicians differently based on the physician’s gender or race?

    Findings  In this randomized trial of 3592 online respondents, simulated physician gender and race did not significantly affect participant satisfaction or confidence in physician clinical judgment compared with a white male physician control.

    Meaning  Participants reported equal satisfaction and confidence in the simulated physicians’ diagnosis and treatment plans regardless of the physician’s gender or race.


    Importance  Women and black physicians encounter workplace challenges because of their gender and race. It is unclear whether these individuals are assessed with lower patient satisfaction or confidence ratings compared with white male physicians.

    Objective  To examine whether physician gender and race affect participant ratings in scenarios in which physician competence is challenged.

    Design, Setting, and Participants  This randomized trial enrolled a geographically diverse sample of 3592 online respondents in the United States who were recruited from 2 crowdsourcing platforms: Amazon Mechanical Turk (n = 1741) and Lucid (n = 1851). A 2 × 2 factorial design for the gender and race of simulated physicians was conducted between March 9 and July 25, 2018. Participants were excluded before intervention if they were younger than 18 years, were pregnant, or had a history of cancer or abdominal surgical procedures.

    Interventions  A clinical vignette was presented to the participant with a picture of the emergency department physician. Participants were randomly assigned to physicians with different gender and race, with 823 assigned to black women, 791 to black men, 828 to white women, and 835 to white men. A contradictory diagnosis from an online symptom checker introduced doubt about the clinical diagnosis.

    Main Outcomes and Measures  A composite outcome (range, 0-100, with 0 representing low patient confidence and satisfaction and 100 representing the maximum on the composite scale) measured participant (1) confidence in the physician, (2) satisfaction with care, (3) likelihood to recommend the physician, (4) trust in the physician’s diagnosis, and (5) likelihood to request additional tests.

    Results  Among 3277 adult participants, complete data were available for 3215 (median age, 49 years [range, 18-89 years]; 1667 [52%] female; 2433 [76%] white). No significant differences were observed in participant satisfaction and physician confidence for the white male physician control physicians (mean composite score, 66.13 [95% CI, 64.76-67.51]) compared with white female (mean composite score, 66.50 [95% CI, 65.19-67.82]), black female (mean composite score, 67.36 [95% CI, 66.03-68.69]), and black male (mean composite score, 66.96 [95% CI, 65.55-68.36]) physicians. Machine learning with bayesian additive regression trees revealed no evidence of treatment effect heterogeneity as a function of participants’ race, gender, racial prejudice, or sexism.

    Conclusions and Relevance  No significant differences were observed for simulated patients’ evaluations of female or black physicians, suggesting that bias in favor of white male physicians is negligible in survey-based measures of patient satisfaction.

    Trial Registration  ClinicalTrials.gov Identifier: NCT04190901