PREVENTIVE CARE FOR WOMEN - DOES THE SEX OF THE PHYSICIAN MATTER

Background. Emphasis on ensuring women's access to preventive health s ervices has increased over the past decade. Relatively little attentio n has been paid to whether the sex of the physician affects the rates of cancer screening among women. We examined differences between male and female physicians in the frequency of screening mammograms and Pap smears among women patients enrolled in a large Midwestern health pla n. Methods. We identified claims for mammography and Pap tests submitt ed by primary care physicians for 97,962 women, 18 to 75 years of age, who were enrolled in the health plan in 1990. The sex of the physicia n was manually coded, and the physician's age was obtained from the st ate licensing board. After identifying a principal physician for each woman, we calculated the frequency of mammography and Pap smears for e ach physician, using the number of women in his or her practice during 1990 as the denominator. Using unconditional logistic regression, we also calculated the odds ratio of having a Pap smear or mammogram for women patients with female physicians as compared with those with male physicians, controlling for the physician's and the patient's age. Re sults. Crude rates for Pap smears and mammography were higher for the patients of female than male physicians in most age groups of physicia ns. The largest differences between female and male physicians were in the rates of Pap smears among the youngest physicians. For the subgro up of women enrolled in the health plan for a year who saw only one ph ysician, after adjustment for the patient's age and the physician's ag e and specialty, the odds ratio for having a Pap smear was 1.99 (95 pe rcent confidence interval, 1.72 to 2.30) for the patients of female ph ysicians as compared with those of male physicians. For women 40 years old and older, the odds ratio for having a mammogram was 1.41 (95 per cent confidence interval, 1.22 to 1.63). For both Pap smears and mammo graphy, the differences between female and male physicians in screenin g rates were much more pronounced in internal medicine and family prac tice than in obstetrics and gynecology. Conclusions. Women are more li kely to undergo screening with Pap smears and mammograms if they see f emale rather than male physicians, particularly if the physician is an internist or family practitioner.