Women's provider preferences for basic gynecology care in a large health maintenance organization

To examine women's preferences for the type and sex of the provider of basi c gynecological services and the correlates of these preferences, we mailed a cross-sectional survey to 8406 women in a large group model health maint enance organization (HMO) in northern California, with a response rate of 7 3.6%. Four questions asked women the type (obstetrician/gynecologist, nurse practitioner, or primary care physician) and sex of provider who performed their last pelvic examination and their preferences in type and sex of pro vider for these examinations. This was a random sample of female HMO member s 35-85 years of age who were empaneled with a primary care physician from one of three categories: family practitioner, general internist, or subspec ialist. Of the 5164 respondents who received their last pelvic examination at Kaiser Permanente, 56% had seen a gynecologist, 26% a nurse practitioner , and only 18% their own primary care physician for the examination. Of the se women, 60.3% reported preferring a gynecologist for basic gynecology car e, 12.6% preferred a nurse practitioner, 13.3% preferred their own primary care physician, and 13.8% had no preference. Patients of family practitione rs were more likely to prefer their own primary care practitioner than pati ents of other types of doctors. The strongest independent predictor of pref erring a gynecologist over the primary care physician was having seen a gyn ecologist for the last pelvic examination (OR = 28.3, p < 0.0001). Other in dependent predictors of preferring a gynecologist were younger age, higher education and income, and having a male primary care physician. Of responde nts, 52.2% preferred a female provider for basic gynecological care, and 42 .0% had no preference for the sex of the provider. Preferring a female prov ider was strongly and independently associated with lower income, higher ed ucation, nonwhite race, having a male primary care physician, having an old er primary care, physician, and having seen a female provider at the last p elvic examination. In this HMO, a majority of women reported a preference f or seeing an obstetrician/gynecologist for their routine gynecological care , despite having a primary care physician. This most likely reflects the st rong influence of previous patient experience and that familiarity with a p articular type of provider leads to preferences for that type. This medical group's structure probably also affects preferences, as in this HMO, prima ry care physicians can be discouraged from performing pelvic examinations. Many women do prefer female providers for pelvic examinations, but a large percentage have no preference. These women often see male providers for bas ic gynecological care. As managed care places increasing emphasis on provid ing integrated, comprehensive primary care, this apparent preference for sp ecialty gynecological care will, require further study.