An Application of the Theory of Representative Bureaucracy, Gender Concordance, and Symbolic Representation in the Health Care Context

Although the United States spends more on health care than comparable nations, many Americans suffer from poor health. Many factors are emphasized as being important for improved health outcomes, including social and economic indicators, living and working conditions, and individual-level behavior. However, I argue the overwhelming attention to male health outcomes—compared to female health outcomes—and focus on factors that are “traditionally understood” as important in shaping health are two limitations of existing health-related research. I adopt an innovative approach that combines the theory of representative bureaucracy, gender concordance, and symbolic representation to argue that increase in female physicians contribute to improved female health outcomes. Using an originally collected dataset that contains information on female physicians, health outcomes, and state and individual-level factors, I study how female physicians influence the health outcomes of non-Hispanic White women, non-Hispanic Black women, and Latinas in the United States from 2000 to 2012. The findings suggest female physicians contribute to improved health outcomes for non-Hispanic White women and non-Hispanic Black women, but not Latinas. Supplemental Analysis bolsters confidence that the findings are not the result of increased access to health care professionals. This study highlights the importance of applying the theory of representative bureaucracy and symbolic representation to health care, the promise of greater female representation in health, and the insight gleaned from incorporating intersectionality in public administration research.

Comparing adult child and spousal caregiver burden and potential causes.

12127 Background: Adult children caring for a parent with cancer comprise a significant segment of caregivers. Demographic trends indicate this caregiving population will grow as the baby boomer generation ages. Yet little is known about adult child caregivers’ needs and experiences and how they differ from the well-studied spousal caregiver. This knowledge gap may hinder efforts to ameliorate adult children’s caregiver burden and its impact on patients. Methods: We analyzed adult child and spousal/partner caregivers’ surveys from the Cancer Care Outcomes Research and Surveillance consortium, a multi-regional population-based study of approximately 10,000 persons with newly diagnosed colorectal and lung cancer. We used t-tests and a series of multivariate regression models to assess whether adult child and spousal caregivers’ caregiving responsibilities, social/emotional burden, and financial burden (scaled 0-10) differed and examined patient and caregiver characteristics’ mediation of variation in burden. Results: Compared to spouses/partners (N=1029), adult children (N=230) completed similar levels of caregiving tasks but spent less time (14 vs. 24 hours/week; p<0.001). However, adult children experienced higher social/emotional burden (2.9 vs. 2.4; p<0.01). In baseline models controlling for patient clinical factors, caregiving characteristics, and caregiver demographics, adult children’s average social/emotional and financial burdens were statistically higher than spouses/partners. Additional adjustment for caregivers’ childcare responsibilities and employment eliminated social/emotional and financial burden disparities. Additional adjustment to the baseline model for caregiver-patient gender concordance eliminated the social/emotional burden gap. Communication quality was a large and statistically significant predictor of both burdens (p<0.001). Conclusions: Adult children spend less time caregiving than spouses/partners but experience higher caregiving burden. Adult children’s childcare and career responsibilities help explain this increased burden. Gender concordance between caregiver and patient may also contribute to social/emotional burden, adding important context to prior research indicating female caregivers experience the greatest burden. Interventions to improve communication between caregivers and patients have the potential to reduce both adult child and spouses/partners caregiver burden.[Table: see text]

Gender Effects in Assessment of Clinical Teaching: Does Concordance Matter?

ABSTRACT Background Gender bias is thought to exist in the assessment of clinical teachers, yet its extent in different specialties is not well-documented nor has it been studied at the individual-dyadic level. Objective The authors sought to determine whether gender bias exists in residents' assessments of faculty teaching in 3 clinical departments, and if present, whether this is influenced by gender concordance or discordance between the faculty and resident. Methods Residents' ratings of faculty in internal medicine (800 faculty, 5753 ratings), surgery (377, 2249), and family medicine (672, 3438) at the University of Toronto from 2016–2017 were analyzed using the overall global rating on a 5-point scale. A mixed-effects linear regression analysis accounted for nesting of ratings within each faculty member. Results Overall scores of teaching effectiveness showed a strong skew to favorable ratings for all faculty and a ceiling effect. However, gender effects differed across departments. In internal medicine (38.5% female faculty), no significant gender effects were detected. In surgery (16.2% female) and family medicine (53.0% female), male faculty received significantly higher scores than female faculty. In surgery this was driven by male residents giving male faculty higher ratings (4.46 vs 4.26, P &lt; .001). In family medicine this was driven by male faculty receiving higher ratings regardless of resident gender (4.65 to 4.57, P &lt; .001). Conclusions Although effects were very small and inconsistent, with gender concordance mattering only for one department, it suggests that gender is a meaningful source of variance in teaching assessments.

Quantifying gender disparity in physician authorship among commentary articles in three high-impact medical journals: an observational study

BackgroundScholarship plays a direct role in career advancement, promotion and authoritative recognition, and women physicians remain under-represented as authors of original research articles.ObjectiveWe sought to determine if women physician authors are similarly under-represented in commentary articles within high-impact journals.Design/Setting/ParticipantsIn this observational study, we abstracted and analysed author information (gender and degree) and authorship position from commentary articles published in three high-impact journals between 1 January 2014 and 16 October 2018.Primary outcome measureAuthorship rate of commentary articles over a 5-year period by gender, degree, authorship position and journal.Secondary outcome measuresTo compare the proportion of men and women physician authorship of commentaries relative to the proportion of men and women physician faculty within academic medicine; and to examine the gender concordance among the last and first authors in articles with more than one author.ResultsOf the 2087 articles during the study period, 48% were men physician first authors compared with 17% women physician first authors (p<0.0001). Of the 1477 articles with more than one author, similar distributions were found with regard to last authors: 55% were men physicians compared with only 12% women physicians (p<0.0001). The proportion of women physician first authors increased over time; however, the proportion of women physician last authors remained stagnant. Women coauthored with women in the first and last authorship positions in 9% of articles. In contrast, women coauthored with men in the first and last author positions, respectively, in 55% of articles.ConclusionsWomen physician authors remain under-represented in commentary articles compared with men physician authors in the first and last author positions. Women also coauthored commentaries with other women in far fewer numbers.