Effect of Resident Gender and Surname Origin on Clinical Load: Observational Cohort Study in an Internal Medicine Continuity Clinic

Background Studies show patients may have gender or racial preferences for physicians. Objective To determine the degree to which physicians’ gender and name characteristics influenced physician clinical load in medical practice, including patient panel size and percent of slots filled. Design Observational cohort study of a continuity clinic site in Rochester, MN, from July 1, 2015 to June 30, 2017 (“historical” period) and July 1, 2018 to January 30, 2020 (“contemporary” period). Participants Internal medicine resident physicians. Main Measures Resident gender, name, and race came from residency management system data. Panel size, percent of appointment slots filled (“slot fill”), panel percent female, and panel percent non-White came from the electronic health record. Multivariable linear regression models calculated beta estimates with 95% confidence intervals and R 2 for the impact of physician gender, surname origin, name character length, and name consonant-to-vowel ratio on each outcome, adjusting for race and year of residency. Key Results Of the 307 internal medicine residents, 122 (40%) were female and 197 (64%) were White. Their patient panels were 51% female (SD 16) and 74% White (SD 6). Female gender was associated with a 5.3 (95% CI 2.7–7.9) patient increase in panel size and a 1.5% (95% CI −0.6 to 3.7) increase in slot fill. European, non-Hispanic surname was associated with a 5.3 (95% CI 2.6–7.9) patient increase in panel size and a 4.3 percent (95% CI 2.1–6.4) increase in slot fill. Race and other name characteristics were not associated with physician clinical load. From the historical to contemporary period, the influence of name characteristics decreased from 9 to 4% for panel size and from 15 to 5% for slot fill. Conclusions Female gender and European, non-Hispanic surname origin are associated with increased physician clinical load—even more than race. While these disparities may have serious consequences, they are also addressable.