WHY DO PATIENTS OF FEMALE PHYSICIANS HAVE HIGHER RATES OF BREAST AND CERVICAL-CANCER SCREENING

OBJECTIVE: Women are more likely to receive breast and cervical cancer screening if they see female physicians, We studied whether this is d ue to differences between male and female physicians, or to difference s in their patients. SETTING: Large midwestern, independent practice a ssociation style of health plan. DESIGN: We surveyed male and female p rimary care physicians matched for age and specialty and a stratified random sample of three of each physician's women patients. Physicians reported on their practice setting, their attitudes and practices rega rding prevention, and their comfort and skill with various examination s. Patients reported on their sociodemographic characteristics, their attitudes and practices regarding prevention, and their preferences fo r physician gender. Claims data were used to calculate mammography and Pap smear screening rates for the physicians. PARTICIPANTS: We studie d 254 female and 190 male internists and family physicians and 794 of their patients. MEASUREMENTS AND MAIN RESULTS: We compared the respons es of male and female physicians and their patients and used multivari able analysis to Identify the patient and physician factors that accou nted for the differences in screening rates between male and female ph ysicians. Female physicians were mole likely to ask new patients about components of prevention, to believe in the effectiveness of mammogra phy, to feel more personal responsibility for ensuring that their pati ents received screening, and to report more comfort in performing Pap smears and breast examinations. Patients of female physicians were mor e educated and less likely to be married, but did not differ in other sociodemographic characteristics. They had similar attitudes and pract ices regarding prevention, except that patients of male physicians wer e more Likely to smoke. Significantly more patients of female physicia ns preferred a female for some component of care, In multivariable ana lyses, practice organization, patient preference for a female physicia n, and prevention orientation of female physicians accounted for up to 40% of screening rate differences between female and male physicians for Pap smears, and 33% for mammography. CONCLUSIONS: Differences in b eliefs of male and female physicians and patient preference for a fema le provider contribute independently to the higher rate of breast and cervical cancer screening by female physicians.