Provision of cancer screening to women in primary care practice: Does physician gender matter?

Background and objectives: Health care providers play an important role in providing clinical preventive services. Studies have documented the impact of female physicians on preventive care but no studies have examined whether physician gender affects preventive services when clinical factors during patient encounters are taken into consideration. This study was designed to examine the effect of physician gender on breast cancer screening and cervical cancer screening services to women during patient visits.

Study design and methods: This is a cross-sectional study using data from the National Ambulatory Medical Care Survey (NAMCS), a nationally-representative survey of visits to office-based physicians excluding anesthesiologists, radiologists, and pathologists. Visits to patients' primary care providers (PCP) by adult women were used in the analysis, excluding visits for prenatal care. The US Preventive Services Task Force (USPSTF) recommendations for breast cancer screening for women age >40 and cervical cancer screening for women age >18 were examined. The effect of physician gender on cancer screening was examined using multivariate logistic regression models which controlled for clinical variables (visit duration, type of visit, prior visits), expected source of payment, patient age and provider age.

Principal findings: From 2001 through 2005, there were an estimated 959.8 million visits made by adult women to their PCPs. At 5.3% the PCP visits, a Pap smear was provided or ordered. A mammogram was ordered at 4.9% of the PCP visits for women age >40. The primary care provider's gender was significantly associated with integrating cancer screening into clinical encounters. Female PCPs had twice the odds of ordering or providing a Pap smear during a patient visit (OR=2.1, 95% CI: 1.7-2.7). Female providers had 1.8 times the odds of male physicians of ordering a mammogram (OR=1.8, 95% CI: 1.4, 2.4). In addition to the effect of provider gender, the study also found that private insurance, longer visit duration, and general medical examination visit were positively associated with cancer screening to women at PCP visits.

Conclusion: This study demonstrates the effect of physician gender on preventive services during clinical encounters. Further research is needed to examine whether the observed female physician gender effect in providing cancer screening services to women reflects physician's practice style or patients' preferences of seeking specific preventive services from female PCPs.