Ann K. Boulis

Racial disparity in analgesic treatment for ED patients with abdominal or back pain.

OBJECTIVE Research on how race affects access to analgesia in the emergency department (ED) has yielded conflicting results. We assessed whether patient race affects analgesia administration for patients presenting with back or abdominal pain. METHODS This is a retrospective cohort study of adults who presented to 2 urban EDs with back or abdominal pain for a 4-year period. To assess differences in analgesia administration and time to analgesia between races, Fisher exact and Wilcoxon rank sum test were used, respectively. Relative risk regression was used to adjust for potential confounders. RESULTS Of 20,125 patients included (mean age, 42 years; 64% female; 75% black; mean pain score, 7.5), 6218 (31%) had back pain and 13,907 (69%) abdominal pain. Overall, 12,109 patients (60%) received any analgesia and 8475 (42%) received opiates. Comparing nonwhite (77 %) to white patients (23%), nonwhites were more likely to report severe pain (pain score, 9-10) (42% vs 36%; P < .0001) yet less likely to receive any analgesia (59% vs 66%; P < .0001) and less likely to receive an opiate (39% vs 51%; P < .0001). After controlling for age, sex, presenting complaint, triage class, admission, and severe pain, white patients were still 10% more likely to receive opiates (relative risk, 1.10; 95% confidence interval, 1.06-1.13). Of patients who received analgesia, nonwhites waited longer for opiate analgesia (median time, 98 vs 90 minutes; P = .004). CONCLUSIONS After controlling for potential confounders, nonwhite patients who presented to the ED for abdominal or back pain were less likely than whites to receive analgesia and waited longer for their opiate medication.

The Evolution of Gender and Motherhood in Contemporary Medicine

In this article, the author endeavors to clarify the shifting nature of gender and motherhood for women physicians. She examines trends in the gender gap in marriage, divorce, childbearing, work hours, and earnings. The author draws on data from the 1990 and 2000 U.S. decennial censuses and data spanning 1991 to 1997 from the Survey of the Practice Patterns of Young Physicians. Compared with women in the general population, the trends for women physicians have been favorable. Women physicians are more likely to marry and less likely to divorce than are other women. Among employed physicians, gender differences in earnings and work hours are also narrowing slightly. Nevertheless, a gap is growing between female physicians with children and childless women doctors, and a small but growing percentage of young physician mothers are electing to forgo labor force participation entirely. Thus, young physician mothers still suffer significant professional sacrifice.

Gender segregation by specialty during medical school.

Over the past 30 years, the representation of women in the active physician workforce climbed from 6.8% in 1970 to 23.0% in 1997. Moreover, women’s presence in medicine will continue to grow, because 45.8% of all U.S. first-year medical students in 2000 were women. By 2010, women physicians are projected to constitute 29.4% of U.S. physicians. In spite of this dramatic progress, women physicians remain concentrated in relatively few, lower-income medical specialties and are less likely than are men to hold tenured faculty positions. In addition to their effects on women physicians, gender disparities in medicine may have implications for patient care. Patients who desire providers of a specific sex but cannot access them may be more reluctant to seek medical care initially and less compliant when they ultimately end up with providers whom they do not trust. Having providers of a specific sex has been shown to influence the satisfaction of women seeking prenatal care, and satisfaction has been associated with patients’ compliance. It follows that a similar preference for women physicians may exist for women seeking other types of sensitive care, such as treatment for breast cancer or urologic disorders. Although the supply of women obstetricians has grown substantially, the availability of women breast surgeons and urologists remains very low. Further, data suggesting that substantial numbers of women prefer women primary care physicians may imply that some women prefer to see women providers for all of their health care needs. In addition, a number of studies have suggested that women physicians differ from their men counterparts with respect to time spent with patients and attention devoted to preventive health. Women physicians may also treat certain conditions more aggressively. Thus, the presence of women across a broad range of specialties may affect patient care in a number of different ways. There is extensive literature investigating why men and women medical students pursue different specialties. These studies suggest that demographic characteristics, personal values, and/or unique family responsibilities are responsible for gender differences in specialty choice. Surprisingly, little effort has been made to assess the role of academic experience in promoting gender segregation across specialties. Coffin and Babbot found that the gender disparity in interest in pediatrics grew during medical school. Several studies have documented an association between medical school experiences and specialty choices, and at least one study suggests that women and men have different experiences in medical school. In this study, we used the well-established sociologic concept of segregation to describe differences in distributions. We specifically examined how gender segregation across specialties has changed during the past 20 years and how gender segregation changes during medical school. In so doing, we began to assess whether the entry of women into medicine: (1) causes the profession to become woman-dominated; (2) exacerbates the concentration of women in a few, lower-income, specialties; or (3) encourages the equal representation of men and women in the profession. This analysis sheds light on whether specialties are continuing to integrate, as Jacobs found for the 1970s and 1980s, or whether a process of resegregation by gender is occurring in the medical profession, as Reskin and Roos suggest. The analysis also indicates whether the process of gender segregation is fixed at entrance to medical school, or reproduced during medical school. Methods

An Analysis of the Impact of Gender on Physician Practice Patterns

Abstract Through analysis of Community Tracking Study Physician Survey, a nationally representative survey of U.S. physicians, we find that women physicians are significantly less satisfied with time for patients than their male colleagues. Among primary care physicians, about one third of the gender difference is explained by physician attributes, practice characteristics, geographical location and patient profiles. Control variables explain all of the gender gap among specialist physicians. Among primary care physicians, the effects of practice type and perceptions of patient complexity on satisfaction with time for patients are mediated by physician gender. Among specialist physicians, gender interacts with practice ownership and hours spent in medically related activity to determine satisfaction with time for patients.

Medicine as a Family-Friendly Profession?

Over the past 3 decades, women have poured into the US labor force. Between 1970 and 2005, the percent of adult women working for pay increased from 43.3 to 59.3%. Women not only increased their participation in the labor force, they also increased their commitment to it. While 40% of employed women worked full-time year round in 1970, approximately 60% did so in 2004 (U.S. Bureau of Labor Statistics 2006).