Physician Sex Research Articles

32948 Characteristics of physicians accepting Medicaid for Mohs micrographic surgery: A cross-sectional analysis

Medicaid beneficiaries face significant barriers to accessing dermatologic care nationally. There is a paucity of data regarding Medicaid beneficiary access to Mohs micrographic surgery (MMS), the preferred treatment for the increasing incidence of skin cancers. In this cross-sectional analysis of all physicians performing MMS in the United States, we sought to characterize the extent and characteristics of Mohs surgeons accepting Medicaid. Our sample included all physicians who billed more than 10 MMS procedures based on the 2017 Medicare Provider Utilization data, as well as the MMS fellowship graduates from 2017 to 2020. Medicaid acceptance status was determined by searching publicly available state-specific Medicaid provider directories and verified by phone call to the physician’s practice. Our results suggest that the majority (60.5%) of physicians performing MMS do not accept Medicaid. Medicaid acceptance stratified by physician sex, practice setting, geographic region, years since medical school graduation, median household income in county of practice and density of Mohs surgeons in county of practice showed statistically significant intergroup differences (P < .05). Our findings reveal potential gaps in access to MMS for socioeconomically disadvantaged populations. Patient access to MMS may be dictated by patient insurance, individual surgeon or location characteristics. Disparities in access to MMS may ultimately yield disproportionately worse health outcomes for the Medicaid beneficiary population.

Change in Physician Burnout between 2013 and 2020 in a Major Health System.

Assessing changes in physician burnout over time can offer insight into the causes of burnout. Existing studies are limited by using different samples of physicians at each time point. Our objective was to assess changes in burnout between 2013-2014 and 2019-2020 overall and within a cohort of physicians who took the survey twice. This is a longitudinal cohort and cross-sectional study of physicians in a major health system. They were administered the Maslach Burnout Inventory in 2013-2014 and 2019-2020. We separately assessed differences in odds of burnout and its subscales in 2013-2014 and 2019-2020 by physician characteristics and clinical time. We then assessed differences in the odds of reporting burnout and its subscales in 2019-2020 compared with 2013-2014 overall and by physician sex, race, and change in clinical full-time employment. There were 1220 respondents in 2013-2014, 503 in 2019-2020, and 149 who responded at both time points. Burnout increased from 35% to 56%. Compared with 2013-2014, physicians had 2.39 higher odds (95% confidence interval [CI] 1.92-2.98) of burnout in 2019-2020, and this change in burnout was significantly more pronounced for female versus male physicians (odds ratio 1.80; 95% CI 1.57-1.80). Compared with White physicians, non-White physicians had significantly lower odds of burnout at both time points, but their odds increased significantly more over time (odds ratio 1.36; 95% CI 1.05-1.57). We found a substantial increase in burnout over time, which was particularly pronounced for non-White and female physicians. Assessment over time is essential for understanding problematic trajectories of burnout that may be obscured by cross-sectional studies.

Reasons Office-Based Physicians in the United States Recommend Common Complementary Health Approaches to Patients: An Exploratory Study Using a National Survey.

Objective: To examine the reasons why office-based physicians do or do not recommend four selected complementary health approaches to their patients in the context of the Andersen Behavioral Model. Design: Descriptive estimates of physician-level data from the 2012 National Ambulatory Medical Care Survey (NAMCS) Physician Induction Interview, a nationally representative survey of office-based physicians (N = 5622, weighted response rate = 59.7%). Setting/Location: The United States. Outcome measures: Reasons for the recommendation or lack thereof to patients for: herbs and other non-vitamin supplements, chiropractic/osteopathic manipulation, acupuncture, and mind-body therapies (including meditation, guided imagery, and progressive relaxation). Differences by physician sex and medical specialty were described. Results: For each of the four complementary health approaches, more than half of the physicians who made recommendations indicated that they were influenced by scientific evidence in peer-reviewed journals (ranging from 52.0% for chiropractic/osteopathic manipulation [95% confidence interval, CI = 47.6-56.3] to 71.3% for herbs and other non-vitamin supplements [95% CI = 66.9-75.4]). More than 60% of all physicians recommended each of the four complementary health approaches because of patient requests. A higher percentage of female physicians reported evidence in peer-reviewed journals as a rationale for recommending herbs and non-vitamin supplements or chiropractic/osteopathic manipulation when compared with male physicians (herbs and non-vitamin supplements: 78.8% [95% CI = 72.4-84.3] vs. 66.6% [95% CI = 60.8-72.2]; chiropractic/osteopathic manipulation: 62.3% [95% CI = 54.7-69.4] vs. 47.5% [95% CI = 42.3-52.7]). For each of the four complementary health approaches, a lack of perceived benefit was the most frequently reported reason by both sexes for not recommending. Lack of information sources was reported more often by female versus male physicians as a reason to not recommend herbs and non-vitamin supplements (31.4% [95% CI = 26.8-36.3] vs. 23.4% [95% CI = 21.0-25.9]). Conclusions: There are limited nationally representative data on the reasons as to why office-based physicians decide to recommend complementary health approaches to patients. Developing a more nuanced understanding of influencing factors in physicians' decision making regarding complementary health approaches may better inform researchers and educators, and aid physicians in making evidence-based recommendations for patients.

Association Between Surgeon and Anesthesiologist Sex Discordance and Postoperative Outcomes: A Population-based Cohort Study.

The aim of this study was to examine the effect of surgeon-anesthesiologist sex discordance on postoperative outcomes. Optimal surgical outcomes depend on teamwork, with surgeons and anesthesiologists forming two key components. There are sex and sex-based differences in interpersonal communication and medical practice which may contribute to patients' perioperative outcomes. We performed a population-based, retrospective cohort study among adult patients undergoing 1 of 25 common elective or emergent surgical procedures from 2007 to 2019 in Ontario, Canada. We assessed the association between differences in sex between surgeon and anesthesiologists (sex discordance) on the primary endpoint of adverse postoperative outcome, defined as death, readmission, or complication within 30 days following surgery using generalized estimating equations. Among 1,165,711 patients treated by 3006 surgeons and 1477 anesthesiologists, 791,819 patients were treated by sex concordant teams (male surgeon/male anesthesiologist: 747,327 and female surgeon/female anesthesiologist: 44,492), whereas 373,892 were sex discordant (male surgeon/female anesthesiologist: 267,330 and female surgeon/male anesthesiologist: 106,562). Overall, 12.3% of patients experienced >1 adverse postoperative outcomes of whom 1.3% died. Sex discordance between surgeon and anesthesiologist was not associated with a significant increased likelihood of composite adverse postoperative outcomes (adjusted odds ratio 1.00, 95% confidence interval 0.97-1.03). We did not demonstrate an association between intraoperative surgeon and anesthesiologist sex discordance on adverse postoperative outcomes in a large patient cohort. Patients, clinicians, and administrators may be reassured that physician sex discordance in operating room teams is unlikely to clinically meaningfully affect patient outcomes after surgery.

Physicians' Perceptions of Clinical Utility of a Digital Health Tool for Electronic Patient-Reported Outcome Monitoring in Real-Life Hematology Practice. Evidence From the GIMEMA-ALLIANCE Platform.

Digital health tools are increasingly being used in cancer care and may include electronic patient-reported outcome (ePRO) monitoring systems. We examined physicians’ perceptions of usability and clinical utility of a digital health tool (GIMEMA-ALLIANCE platform) for ePRO monitoring in the real-life practice of patients with hematologic malignancies. This tool allows for the collection and assessment of ePROs with real-time graphical presentation of results to medical staff. Based on a predefined algorithm, automated alerts are sent to medical staff. Participating hematologists completed an online survey on their experience with the platform. Of the 201 patients invited to participate between December 2020 and June 2021 (cut-off date for current analysis), 180 (90%) agreed to enter the platform and had a median age of 57 years. Twenty-three hematologists with a median age of 42 years and an average of 17 years of experience in clinical practice were surveyed. All hematologists agreed or strongly agreed that the platform was easy to use, and 87%, agreed or strongly agreed that ePROs data were useful to enhance communication with their patients. The majority of physicians (78%) accessed the platform at least once per month to consult the symptom and health status profile of their patients. The frequency of access was independent of physician sex (p=0.393) and years of experience in clinical practice (p=0.404). In conclusion, our preliminary results support the clinical utility, from the perspective of the treating hematologist, of integrating ePROs into the routine cancer care of patients with hematologic malignancies.

Does Industry Sponsorship Influence Research Productivity Among Foot and Ankle Surgeons?

Category:Ankle; Basic Sciences/Biologics; OtherIntroduction/Purpose:Research productivity and success drive academic promotions in surgeons' careers. While previous studies have shown a strong relationship between research funding and academic productivity, few have analyzed that relationship in Foot and Ankle surgery. Furthermore, they have primarily used bibliometric data, such as the Hirsch index (h-index), which although is representative of an author's impact, heavily favors physicians who have been in practice longer. There is a need for more pragmatic variables that take into account career longevity. Because there is deficient literature in the analysis of the association between industry sponsorship and research productivity among foot and ankle surgeons, we sought to narrow the gap.Methods:A retrospective review of all articles from the 2018 issues of Foot and Ankle International Journal, Journal of Foot and Ankle Surgery and Clinical Research on Foot and Ankle Journal were queried for authors. 303 unique United States-based non trainee Foot and Ankle authors were identified, and ultimately included in the study. They were analyzed for demographic data including sex, academic title, years in practice, and specialty. We also collected bibliometric data from Scopus, including total publications, Hirsch index (h-index), m-index, and publications-to-years in practice ratio. The Center for Medicare & Medicaid Services Open Payments Database was reviewed, and total payments were collected for each author. Authors were divided into quartiles based on payment data (i.e., Quartile 1: 0-25%, etc.) for analysis. Kruskal Wallis and Mann-Whitney U tests were performed to identify significant differences between groups. A Multivariate logistic regression was performed to identify independent predictors of high research productivity.Results:A total of 253 (83.5%) of authors had received at least one payment. The payments received by the authors were broken down in the following quartiles.: Quartile 1, (n=77) who had payments of 0 to $171.41; Quartile 2: (n=76) $171.42 to $2515.15; Quartile 3: (n=76): $2515.16 to $34,577.36; and Quartile 4: (n=74) $34,577.37 to $8,530,326.50. Total Publication Count, H- index, M-index and publications to years in practice ratio all were significantly different and increasing between quartiles (p<0.001 for all). Multivariate logistic regressions identified both Academic status (p<0.001) and Total payments (p<0.05) as contributing factors to total number of publications, publications per year ratio, h-index and m-index, while Author order also contributed to higher h-index. Physician Sex or Level of Evidence were not significant independent contributors to the total number of publications, H-Index, M-Index or publications per year ratio in our study.Conclusion:We identified that both industry payments and academic status are significantly correlated with higher research productivity among Foot and Ankle authors. Being the last author on a research also correlated with increased productivity. While h-index and total publications measure the research output, they fail to account for time as a confounding variable, where an individual who has been active longer in research can potentially have a higher research output. The m-index, (which is H-index divided by number of years that an author has been active) and publications-per-year ratio takes that into account, and yet our findings remained significant.

Sex Differences in the Pattern of Patient Referrals to Male and Female Surgeons

Studies have found that female surgeons have fewer opportunities to perform highly remunerated operations, a circumstance that contributes to the sex-based pay gap in surgery. Procedures performed by surgeons are, in part, determined by the referrals they receive. In the US and Canada, most practicing physicians who provide referrals are men. Whether there are sex-based differences in surgical referrals is unknown. To examine whether physicians' referrals to surgeons are influenced by the sex of the referring physician and/or surgeon. This cross-sectional, population-based study used administrative databases to identify outpatient referrals to surgeons in Ontario, Canada, from January 1, 1997, to December 31, 2016, with follow-up to December 31, 2018. Data analysis was performed from April 7, 2019, to May 14, 2021. Referring physician sex. This study compared the proportion of referrals (overall and those referrals that led to surgery) made by male and female physicians to male and female surgeons to assess associations between surgeon, referring physician, or patient characteristics and referral decisions. Discrete choice modeling was used to examine the extent to which sex differences in referrals were associated with physicians' preferences for same-sex surgeons. A total of 39 710 784 referrals were made by 44 893 physicians (27 792 [61.9%] male) to 5660 surgeons (4389 [77.5%] male). Female patients made up a greater proportion of referrals to female surgeons than to male surgeons (76.8% vs 55.3%, P < .001). Male surgeons accounted for 77.5% of all surgeons but received 87.1% of referrals from male physicians and 79.3% of referrals from female physicians. Female surgeons less commonly received procedural referrals than male surgeons (25.4% vs 33.0%, P < .001). After adjusting for patient and referring physician characteristics, male physicians referred a greater proportion of patients to male surgeons than did female physicians; differences were greatest among referrals from other surgeons (rate ratio, 1.14; 95% CI, 1.13-1.16). Female physicians had a 1.6% (95% CI, 1.4%-1.9%) greater odds of same-sex referrals, whereas male physicians had a 32.0% (95% CI, 31.8%-32.2%) greater odds of same-sex referrals; differences did not attenuate over time. In this cross-sectional, population-based study, male physicians appeared to have referral preferences for male surgeons; this disparity is not narrowing over time or as more women enter surgery. Such preferences lead to lower volumes of and fewer operative referrals to female surgeons and are associated with sex-based inequities in medicine.

Clinical Utility and Physician Perceptions of a Digital Platform for Electronic Patient-Reported Outcomes Monitoring in Patients with Hematologic Malignancies in Real-World Practice

Clinical Utility and Physician Perceptions of a Digital Platform for Electronic Patient-Reported Outcomes Monitoring in Patients with Hematologic Malignancies in Real-World Practice

Hopelessness in New York State Physicians During the First Wave of the COVID-19 Outbreak.

In the United States, New York State's health care system experienced unprecedented stress as an early epicenter of the coronavirus disease 2019 (COVID-19) pandemic. This study aims to assess the level of hopelessness in New York State physicians working on the frontlines during the first wave of the COVID-19 outbreak. A confidential online survey sent to New York State health care workers by the state health commissioner's office was used to gather demographic and hopelessness data as captured by a brief Hopelessness Scale. Adjusted linear regression models were used to assess the associations of physician age, sex, and number of triage decisions made, with level of hopelessness. In total, 1330 physicians were included, of whom 684 were male (51.4%). Their average age was 52.4 years (SD=12.7), with the majority of respondents aged 50 years and older (55.2%). Almost half of the physician respondents (46.3%) worked directly with COVID-19 patients, and 163 (12.3%) were involved in COVID-19-related triage decisions. On adjusted analysis, physicians aged 40 to 49 years had significantly higher levels of hopelessness compared with those aged 50 years or more (μ=0.441, SD=0.152, P=0.004). Those involved in 1 to 5 COVID-19-related triage decisions had a significantly lower mean hopelessness score (μ=-0.572, SD=0.208, P=0.006) compared with physicians involved in none of these decisions. Self-reported hopelessness was significantly higher among physicians aged 40 to 49 years and those who had not yet been involved in a life or death triage decision. Further work is needed to identify strategies to support physicians at high risk for adverse mental health outcomes during public health emergencies such as the COVID-19 pandemic.

227 Gender Coding in Physician Job Advertisements and Sex Disparities in Medical and Surgical Fields

Research in engineering fields has shown that using masculine or feminine coded language in job advertisements affects the proportion of men vs. women applying for those jobs, and that changing such wording alters the applicant pool in a way that improves diversity. In medicine, there are fields that are traditionally heavily male-dominated, such as surgery, and fields that attract more women, such as family practice, obstetrics, and pediatrics. We sought to determine if sex coded language in physician job advertisements reflects the sex disparities in medical and surgical fields. This was a cross sectional study of all physician job advertisements on 16 academic and non-academic medical job databases from September 2020-February 2021. Job advertisements were cut and pasted verbatim for the purposes of the study. Using a sex decoder program based on prior research by Gaucher et al on sexed wording in job advertisements, we analyzed each job to determine if the job advertisement contained any sex coded words and if the advertisement was overall highly masculine, masculine, highly feminine, feminine, or neutral. Region of the country, requirement for subspecialty training, and field (emergency medicine (EM), internal medicine (IM), surgery, pediatrics, obstetrics (OB), family practice (FP), and multiple fields) were also recorded. Data was reviewed and duplicate listings were deleted. Data were analyzed using descriptive statistics and logistic regression. The study was reviewed by the IRB and found to be exempt. 509 jobs were posted to the study websites during the study period. The jobs included 193 IM jobs (37.9%), 89 surgery jobs (17.5%), 74 EM jobs (14.5%), 63 FP jobs (12.4%), 41 pediatric jobs (8.1%), 29 OB jobs (5.7%). 43.6% of job advertisements coded as masculine or strongly masculine (M), 35.4% coded as feminine or strongly feminine (F), 20.8% coded as neutral (N). Of those neutral coded jobs, only 19 advertisements (3.7%) had no sex coded language at all. Region of the country and requirement for subspecialty training were not associated with sex coding. Field of practice was predictive of sex coding, with pediatrics (29.3%M, 54.8%F) and OB (24.1%M, 41.4%F) more commonly having feminine coded language and IM (48.7%M, 31.6%F) and EM (54.8%M, 25%F) having disproportionately more masculine coded job advertisements (p=0.001). Surgery (36%M, 39.3%F) and FP (39.7%M, 39.7%F) were more balanced. This is consistent with the sex proportion of some fields, such as OB and pediatrics, which have 59% and 64% women in practice respectively, and EM and IM, which have 72% and 61% men in practice, respectively. Surgical job advertisements are less commonly masculine coded, although the specialty is 78% male. Job advertisements for medical positions often contain sex coded language that may reduce the diversity of the applicant pool. For most medical fields, this sexed language is in keeping with the sex make-up of the specialty. Further studies should focus on whether modification of recruitment materials impacts applicant pool diversity.

326 Resident Attitudes Towards Performing Pelvic Exams in the Emergency Department

Mounting evidence suggests that emergency physicians tend to avoid patients with gynecologic chief complaints. In one study of all emergency department (ED) visits, patient pickup time was 12 minutes for the chief complaint of vaginal bleeding compared to a median pickup time of 6 minutes for all other complaints (Patterson et al, AEM, 2016). A recent study found that male EM residents were less likely than female EM residents to assign themselves to patients with vaginal bleeding (Agarwal et al, AJEM, 2021). We hypothesized that an underlying reason could be discomfort with performing a pelvic exam. The goal of this study was to assess whether male EM residents report greater discomfort with pelvic exams than female EM residents. We performed a cross-sectional, IRB-approved survey of EM residents at five academic programs. Of 100 residents who completed the survey, 63 self-identified as male, 36 as female, and one selected “prefer not to say” and was excluded from analysis. Residents were asked about their personal comfort with performing pelvic exams, with response options of “very comfortable, ” “hesitate to do, ” “do not feel comfortable, ” or “avoid doing whenever possible.” Responses were compared between male and females using a chi-square test. In secondary analysis, we used a t-test to compare preferences for various chief complaints as well as frequency of performing pelvic exams. Self-reported comfort with pelvic exams did not differ significantly between males and females (p=0.4249). Females reported a slightly higher, though not statistically significant, number of pelvic exams performed over a span of five shifts (mean=2.1, CI=1.6-2.5) than males (mean=1.7, CI=1.3-2.0). Self-reported barriers for male respondents in performing pelvic exams include lack of training, general dislike, and concern that the patient will want a female provider. However, 67% (CI=54%-78%) of male residents reported supervised pelvic exams with faculty in the ED as part of their training, compared to 36% (CI=21%- 54%) of female residents. On a preference scale of 1-5, male residents had a statistically significant lower preference ranking for patients with a chief complaint of vaginal bleeding compared to female residents (mean difference=0.48, CI=0.11, 0.87). Preference ranking was the same between male and females on other chief complaints. There is a sex disparity among male and female EM residents in attitudes towards patients with vaginal bleeding. However, the results from this study do not demonstrate a significant difference in self-reported comfort amongst male and female residents in performing pelvic exams. This may be due to reporting bias, or this disparity may be driven by other barriers including self-reported lack of training and concern about patients’ physician sex preferences.

Assessment of Accuracy of a Physician Ratings Website in One Metropolitan Area

Patients frequently use online physician ratings websites (PRWs) to identify physicians for care. PRWs provide physician information and reviews. However, the accuracy of PRWs is uncertain. We investigated the accuracy and validity of Healthgrades with respect to endocrine surgery. We identified factors associated with reported board certification inaccuracy, higher ratings, greater quantity of ratings. The search term "endocrine surgery specialist" was used and the search was limited to a 25-mile radius around Philadelphia, PA. Data was collected on physician sex, age, board certification, surgical specialty, quantity of ratings, average rating, response to comments, and provision of a self-description. Descriptive statistics were performed to examine surgeon characteristics, ratings, and reported board certifications. Board certification accuracy was determined by searching the corresponding American Board website and calculating a kappa statistic. Logistic regression was performed to identify factors associated with board certification inaccuracy, higher average ratings, and higher quantity of ratings. A total of 300 physicians were identified. Eighty-four percent of listed board certifications were accurate; the kappa statistic for accuracy of board certification was 0.634. Providing a response to comments and greater quantity of ratings were associated with higher average ratings. Provision of a self-description, male sex, and younger age were identified as factors associated with higher quantity of ratings. A wide range of specialties are identified as endocrine surgery specialists. The reliability of board certification reporting was moderate. Increased surgeon involvement with the Healthgrades site was inconsistently associated with higher average ratings and higher quantity of ratings but lower accuracy.

Impact of surgeon and anaesthesiologist sex on patient outcomes after cardiac surgery: a population-based study

BackgroundEffective teamwork between anaesthesiologists and surgeons is essential for optimising patient safety in the cardiac operating room. While many factors may influence the relationship between these two physicians, the role...

Personal Formularies of Primary Care Physicians Across 4 Health Care Systems

More conservative prescribing has the potential to reduce adverse drug events and patient harm and cost; however, no method exists defining the extent to which individual clinicians prescribe conservatively. One potential domain is prescribing a more limited number of drugs. Personal formularies-defined as the number and mix of unique, newly initiated drugs prescribed by a physician-may enable comparisons among clinicians, practices, and institutions. To develop a method of defining primary care physicians' personal formularies and examine how they differ among primary care physicians at 4 institutions; evaluate associations between personal formularies and patient, physician, and practice site characteristics; and empirically derive and examine the variability of the top 200 core drugs prescribed at the 4 sites. This retrospective cohort study was conducted at 4 US health care systems among 4655 internal and family medicine physicians and 4 930 707 patients who had at least 1 visit to these physicians between January 1, 2017, and December 31, 2018. Personal formulary size was defined as the number of unique, newly initiated drugs. Personal formulary size and drugs used, physician and patient characteristics, core drugs, and analysis of selected drug classes. The study population included 4655 primary care physicians (2274 women [48.9%]; mean [SD] age, 48.5 [4.4] years) and 4 930 707 patients (16.5% women; mean [SD] age, 51.9 [8.3] years). There were 41 378 903 outpatient prescriptions written, of which 9 496 766 (23.0%) were new starts. Institution median personal formulary size ranged from 150 (interquartile range, 82.0-212.0) to 296 (interquartile range, 230.0-347.0) drugs. In multivariable modeling, personal formulary size was significantly associated with panel size (total number of unique patients with face-to-face encounters during the study period; 1.2 medications per 100 patients), physician's total number of encounters (5.7 drugs per 10% increase), and physician's sex (-6.2 drugs per 100 patients for female physicians). There were 1527 unique, newly prescribed drugs across the 4 sites. Fewer than half the drugs (626 [41.0%]) were used at every site. Physicians' prescribing of drugs from a pooled core list varied from 0% to 100% of their prescriptions. Personal formularies, measured at the level of individual physicians and institutions, reveal variability in size and mix of drugs. Similarly, defining a list of commonly prescribed core drugs in primary care revealed interphysician and interinstitutional differences. Personal formularies and core medication lists enable comparisons and may identify outliers and opportunities for safer and more appropriate prescribing.

Racial and Ethnic Bias Impact Perceptions of Surgeon Communication.

To evaluate patient satisfaction scores as a function of physician and patient race and sex. Patient satisfaction is increasingly used as a surrogate for physician performance. How patient and surgeon race and ethnicity affect perceptions of surgeon communication and care is not widely explored. Press Ganey patient satisfaction surveys collected from January 2019 to September 2020 were studied. Multivariate logistic regressions were used to identify factors associated with favorable surgeon performance as a function of patient and surgeon demographics. A total of 4732 unique outpatient satisfaction survey responses were analyzed. The majority of patients were White (60.5%), followed by Asian (8.6%), Black (4.2%), and Hispanic (4.3%). URM accounted for 8.9% of the 79 surgeons evaluated, and 34% were female. Black, Hispanic, and Asian patients were more likely to report unfavorable experiences than their White counterparts (P < 0.01). Spanish-speaking patients were most likely to perceive that surgeon show less respect for patient concerns (13.9% vs 9.3%, P = 0.004) and inadequate time spent explaining health concerns (12.6% vs 9.2%, P < 0.001). Female surgeons were more likely to achieve the highest overall ratings for effective communication, whereas Asian surgeons received lower scores. Asian surgeons were more likely than non-Asian surgeons to receive lower scores in explanation (37.3% vs 44.1%, P = 0.003). After adjusting for confounding factors, Asian surgeons had 26% lower odds of receiving favorable scores for overall communication (odds ratio: 0.736, 95% confidence interval: 0.619-0.877, P = 0.001). Both patient and surgeon race and sex drive negative perceptions of patient-physician communication. As URM report more negative experiences, further studies should focus on effects of surgeon cultural awareness on underrepresented patient satisfaction.

BREAKING BAD NEWS IN HEAD AND NECK CANCER PATIENTS

<h3>Background</h3> Breaking bad news is a distressing situation for both patients and physicians. Physician communication should contemplate patient preferences for an effective process. <h3>Objective</h3> To evaluate the communication process of breaking bad news in head and neck cancer patients according to their perception and satisfaction. <h3>Methods</h3> A total of 100 patients diagnosed with head and neck cancer were interviewed. An instrument based on the Breaking Bad News Assessment Schedule was applied to measure perception of the diagnostic information as well as patient satisfaction according to SPIKES protocol standards (Setting up, Perception, Invitation, Knowledge, Emotions, Strategy and Summary). Data were analyzed using Student <i>t</i> test and the chi-square test. <i>P</i> < .05 was considered statistically significant. <h3>Results</h3> Forty women and 60 men with an average age of 57.96 ± 14.84 years were interviewed. Satisfaction percentage was 85%. An excellent/good perception was reported in 87 patients. Physician sex, age, or healthcare sector variables were not associated with patient satisfaction and perception. Medical specialty was statistically related to the satisfaction and perception of patients. Best scores were obtained by oncologist surgeons and oral medicine practitioners (<i>P</i> = .001). <h3>Conclusions</h3> In general, cancer patients were satisfied with professionals' ability to provide adequate information using good communication skills. Physicians who occasionally manage cancer patients were not prepared to deliver the diagnosis. The provision of the truth as well as emotional support was highly appreciated by patients.

P632 Is the gender or age of the physician key to a good physician-patient with Inflammatory Bowel Disease relationship?

Abstract Background The importance of good patient-physician relationship in chronic diseases, including Inflammatory Bowel Disease (IBD), is well stablished. Empathy has become one of the most important researches items in terms of patient-physician relationship because it is positive influence on the quality of care. The aim of the study was to assess the level of IBD specialist physician′s empathy as perceived by their patients and if it varies according to the age and gender of the patient and the physician. Methods This is a national cross-sectional study. Recruitment was conducted between July and November of 2020 by sending a voluntary online survey to IBD patients who take part of Spanish association of patients with IBD (ACCU España). The survey included CARE (Consultation and Relational Empathy) scale (maximum score 50 points and minimum 10 points). Results Five hundred sixty one responses to the survey were received. After applying exclusion criteria, 536 patients were included in the analysis. Total median score of CARE scale was 44.50 (IQR 31.25–50.00), that reflects a very good punctuation. Most of the patients (531 (99.1%)) considered the contents of the questionnaire to be an important issue. Analyzing CARE scale scores of cases in which the sex of patient and physician were the same compared who did not, no statistically significant differences were found. No differences were found either, comparing punctuation of CARE scale based on patient-physician age ranges as is shown in Table 1. n (%): Absolute frequency (percentage). *Median (IQR). **Univariate analysis performed with U Mann-Whitney test or Kruskal-Wallis Conclusion Spanish IBD patients have a great IBD specialist empathy perception, which is the key to a good patient-physician relationship, and this fact is not influenced by age or gender of patients or physicians.

The DISCO study-Does Interventionalists' Sex impact Coronary Outcomes?

To examine the association of operator sex with appropriateness and outcomes of percutaneous coronary intervention (PCI). Recent studies suggest that physician sex may impact outcomes for specific patient cohorts. There are no data evaluating the impact of operator sex on PCI outcomes. We studied the impact of operator sex on PCI outcome and appropriateness among all patients undergoing PCI between January 2010 and December 2017 at 48 non-federal hospitals in Michigan. We used logistic regression models to adjust for baseline risk among patients treated by male versus female operators in the primary analysis. During this time, 18 female interventionalists and 385 male interventionalists had performed at least one PCI. Female interventionalists performed 6362 (2.7%) of 239,420 cases. There were no differences in the odds of mortality (1.48% vs. 1.56%, adjusted OR [aOR] 1.138, 95% CI: 0.891-1.452), acute kidney injury (3.42% vs. 3.28%, aOR 1.027, 95% CI: 0.819-1.288), transfusion (2.59% vs. 2.85%, aOR 1.168, 95% CI: 0.980-1.390) or major bleeding (0.95% vs. 1.07%, aOR 1.083, 95% CI: 0.825-1.420) between patients treated by female versus male interventionalist. While the absolute differences were small, PCIs performed by female interventional cardiologists were more frequently rated as appropriate (86.64% vs. 84.45%, p-value <0.0001). Female interventional cardiologists more frequently prescribed guideline-directed medical therapy. We found no significant differences in risk-adjusted in-hospital outcomes between PCIs performed by female versus male interventional cardiologists in Michigan. Female interventional cardiologists more frequently performed PCI rated as appropriate and had a higher likelihood of prescribing guideline-directed medical therapy.

Factors Associated With Clinical Recovery After Concussion in Youth Ice Hockey Players.

Background:The identification of factors associated with clinical recovery in youth after sports-related concussion could improve prognostication regarding return to play (RTP).Purpose:To assess factors associated with clinical recovery after concussion in youth ice hockey players.Study Design:Cohort study; Level of evidence, 2.Methods:Participants were part of a larger longitudinal cohort study (the Safe to Play study; N = 3353). Included were 376 ice hockey players (age range, 11-17 years) from teams in Calgary and Edmonton, Canada, with 425 physician-diagnosed ice hockey–related concussions over 5 seasons (2013-2018). Any player with a suspected concussion was referred to a sports medicine physician for diagnosis, and a Sport Concussion Assessment Tool (SCAT) form was completed. Time to clinical recovery was based on time between concussion and physician clearance to RTP. Two accelerated failure time models were used to estimate days to RTP clearance: model 1 considered symptom severity according to the SCAT3/SCAT5 symptom evaluation score (range, 0-132 points), and model 2 considered responses to individual symptom evaluation items (eg, headache, neck pain, dizziness) of none/mild (0-2 points) versus moderate/severe (3-6 points). Other covariates were time to physician first visit (≤7 and >7 days), age group (11-12, 13-14, and 15-17 years), sex, league type (body checking and no body checking), tandem stance (modified Balance Error Scoring System result ≥4 errors out of 10), and number of previous concussions (0, 1, 2, and ≥3).Results:The complete case analysis (including players without missing covariates) included 329 players (366 diagnosed concussions). The median time to clinical recovery was 18 days. In model 1, longer time to first physician visit (>7 days) (time ratio [TR], 1.637 [95% confidence interval (CI), 1.331-1.996]) and greater symptom severity (TR, 1.016 [95% CI, 1.012-1.020]) were significant predictors of longer clinical recovery. In model 2, longer time to first physician visit (TR, 1.698 [95% CI, 1.399-2.062]), headache (moderate/severe) (TR, 1.319 [95% CI, 1.110-1.568]), and poorer tandem stance (TR, 1.249 [95% CI, 1.052-1.484]) were significant predictors of longer clinical recovery.Conclusion:Medical clearance to RTP was longer for players with >7 days to physician assessment, poorer tandem stance, greater symptom severity, and moderate/severe headache at first visit.

Differences in Administration of Influenza Vaccine to Elderly Adults by Physician Sex, 2006-2016

Differences in Administration of Influenza Vaccine to Elderly Adults by Physician Sex, 2006-2016