The increasing share of female physicians in OECD countries has sparked interest in understanding how gender influences healthcare provision. Using Austrian register data and a quasi-random assignment of primary care providers (PCPs), a recent research assessed whether assigning patients to female PCPs changes healthcare utilisation, practice performance or patient loyalty. With a difference-in-differences design, the study isolated causal effects of PCP gender on various outcomes, revealing key insights into practice revenue, patient behaviour and preventive care provision.
Differences in Practice Revenue and Patient Volume
Female PCPs generate approximately 15% less revenue per quarter compared to male counterparts. This difference results from a combination of lower patient volume—female PCPs see 7% fewer patients—and fewer services provided per patient. The revenue gap is not driven by differences in pricing or reimbursement, as all PCPs operate under the same gender-neutral contracts.
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The dynamic analysis shows that male successors tend to increase their revenue after taking over a practice, while female successors maintain or slightly decrease theirs. This divergence suggests that male PCPs may engage more actively in service provision. However, this is not necessarily linked to patient demand or preference but rather to structural and behavioural differences in how male and female PCPs manage their practices.
Patient Retention and Gender Effects
Patients assigned to female PCPs are more likely to change practices than those assigned to male PCPs, with a persistent gap of six percentage points in patient retention over two years. This effect is especially notable in urban areas, where alternative PCP options are more readily available. However, there is no evidence to suggest that patients systematically avoid female doctors due to gender bias. Those who leave a female PCP are no more likely to switch to a male doctor than to another female doctor.
Several factors influence the likelihood of switching. Female, younger and higher-income patients are more prone to changing their PCP. Practice characteristics, such as being in an urban location or undergoing a soft transition (where the outgoing and incoming PCP overlap), also play a role. Importantly, working hours emerge as a key mechanism: female PCPs, especially those with children, tend to work fewer hours, which contributes to the reduced patient volume observed in their practices.
Impact on Healthcare Utilisation and Preventive Services
Despite changes in revenue and patient movement, assigning a female PCP does not significantly affect total healthcare utilisation or health outcomes. For patients who remain with their assigned female PCP, there is a modest reduction in quarterly PCP fees—around 6.6%—but no significant change in specialist visits, hospitalisations or drug prescriptions.
Preventive care provision, however, shows some variation. Patients of female PCPs are slightly less likely to undergo general health screenings and receive diabetes-related services. These differences appear to result from male PCPs increasing such services post-replacement, rather than female PCPs reducing their efforts. Importantly, the likelihood of visiting a PCP remains unchanged, indicating that patients continue to seek care at similar rates, regardless of their doctor's gender.
The gender of primary care physicians influences practice-level outcomes but does not markedly alter overall healthcare utilisation or patient health. Female PCPs see fewer patients and generate lower revenues, largely due to reduced working hours, particularly among those with children. While patients assigned to female physicians are more likely to change practices, this behaviour is not driven by gender-based preferences. As more women enter the medical profession, especially in primary care, structural adjustments—such as increased flexibility in work arrangements—may be necessary to ensure equitable healthcare access and efficient service provision.
Source: Journal of Health Economics
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