Health Care Disparities: The Impact of Benevolent Sexism

The present research investigated potential disparities in recommendations for coronary artery disease (CAD) as a function of physician benevolent sexism, patient sex, and surgical risk. In particular, the present study examined (a) whether physicians holding beliefs consistent with benevolent sexism would be more reluctant to recommend invasive treatment options to women, (b) whether physicians would be more hesitant to recommend invasive treatment options to patients of high surgical risk, and (c) the three-way interaction of physician benevolent sexism, patient sex, and surgical risk. Using analog methodology, 108 internal medicine residents and 33 cardiovascular disease fellows recruited from 339 teaching hospitals across the United States made assessments and recommendations regarding care for a hypothetical female or male patient of either low or high surgical risk. Physicians indicated the likelihood they would recommend the following interventions: watchful waiting, lifestyle changes, an intensified medication regimen, percutaneous coronary intervention (PCI), PCI in the presence of comorbid conditions, PCI opposed to an intensified medication regimen, coronary artery bypass graft (CABG) surgery, CABG surgery in the presence of comorbid conditions, and CABG surgery opposed to PCI. Although there were no significant main effects for benevolent sexism, it played a role in some interesting interactions. For example, physicians holding both high scores in benevolent sexism and greater years of experience were less likely to recommend PCI opposed to an intensified medication regimen to the female patient. Furthermore, when surgical risk was low, male physicians scoring high in benevolent sexism were less likely to recommend PCI in the presence of one or more comorbid conditions to the female patient. Findings from this study suggest valuable avenues for future research and have important implications for reducing disparities in care. These implications are thoroughly discussed.