physician gender, physician marriage and the supply and distribution of medical services ann boulis

Physician Gender, Physician Physician Gender, Physician Marriage and the Supply and Marriage and the Supply and

Distribution of Medical Distribution of Medical Services Services

Ann Boulis

Ideas and Research on Ideas and Research on Gender and Medical Service Gender and Medical Service

Supply & DistributionSupply & Distribution

1. Women physicians work less.

2. Women physicians are less likely to live in metropolitan areas.

3. The unique behavior of women physicians stems from their unique approach to work and family.

Key ArticlesKey ArticlesCull, WL, HJ Mulvey, KG O'Connor, DR

Sowell, CD Berkowitz, and CV Britton. 2002. "Pediatricians working part-time: past, present, and future." Pediatrics 109:1015-1102.

Colwill, JM and JM Cultice. 2003. "The future supply of family physicians: implications for rural America." Health Affairs 22:190-8.

Study GoalsStudy Goals

Evaluate prevailing wisdom about women physicians and medical service supply and distribution.

Specifically:– Track trends in work effort and practice location of

ALL physicians by gender.– Track trends in the work effort and practice location of

MARRIED physicians by gender.– Use logistic regression to consider how spousal

characteristics influence the behavior of male and female physicians.

Data and VariablesData and Variables

Sample: 1980, 1990 and 2000 5% Census Samples in the Integrated Public Use Microdata Series

Variables: Physicians are those who self identify and indicate that they have professional level education.

Married physicians are living with their spouse and legally married.

Resident Proxies Excluded

Figure 1: The Percent of Figure 1: The Percent of Physicians Reporting Physicians Reporting

EmploymentEmployment

0.96 0.95 0.950.94 0.95 0.93

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1980 1990 2000

Men

Women

.98 1.00 .98

Figure 2: The Average Work Figure 2: The Average Work Week for Employed Week for Employed

PhysiciansPhysicians51 52 53

4446

48

0

10

20

30

40

50

60

1980 1990 2000

Men

Women

.86 .88 .92

Figure 3: The Percent of Figure 3: The Percent of Employed Physicians Working Employed Physicians Working

<35 Hours Per Week<35 Hours Per Week

7%

8%8%

17%16% 16%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

1980 1990 2000

Men

Women

2.42 2.00 2.00

Figure 4: The Percent of Figure 4: The Percent of Employed Physicians Working Employed Physicians Working

50+ Hours Per Week50+ Hours Per Week

.60 .74 .7763%65% 65%

38%

44%

50%

0%

10%

20%

30%

40%

50%

60%

70%

1980 1990 2000

Men

Women

.60 .74 .77

Figure 5: The Percent of Figure 5: The Percent of Employed Physicians in Non-Employed Physicians in Non-

Metropolitan AreasMetropolitan Areas

19%

20%

16%

12%

15%

12%

0%

5%

10%

15%

20%

25%

1980 1990 2000

Men

Women

.63 .75 .73

Figure 6: The Percent of Figure 6: The Percent of Employed Physicians who are Employed Physicians who are

MarriedMarried0.85 0.85

0.83

0.650.68 0.68

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0.80

0.90

1980 1990 2000

Men

Women

.76 .81 .82

Figure 7: Female/Male Figure 7: Female/Male Average Work Week by Average Work Week by

Marital StatusMarital Status

0.83

0.86

0.89

0.940.95

0.98

0.75

0.80

0.85

0.90

0.95

1.00

1980 1990 2000

Married Female/Male Work Week Unmarried Female/Male Work Week

The Effect of Spousal Employment on the Average Weekly Work Week forEmployed Married Physicians

Unadj Adj Unadj AdjModels Models Models Models

1980 1.12 *** -0.92 * 2.72 -4.58 *1990 2.31 *** -1.54 *** 1.68 -8.38 ***2000 1.59 *** -2.25 *** -1.13 -8.04 ***

Note: Adjusted models control for: spousal education, spousal age, physician age, if spouse is a physician, hours spouse works for pay and spousal earned income.***p<.001, **p<.01 *p<.05

Male Physicians Female Physicians

The Effect of a Having a Spouse with a NonMedical Graduate Degree on Locating Outside Metro Area

Unadj Adj Unadj AdjModels Odds Models Odds Models Odds Models Odds

B Ratio B Ratio B Ratio B Ratio

1980 -0.36 0.70 *** -0.27 0.76 *** -0.75 0.47 * -0.74 0.48 ***1990 -0.47 0.63 *** -0.43 0.65 *** -0.99 0.37 *** -0.94 0.39 ***2000 -0.63 0.54 *** -0.59 0.55 *** -1.08 0.34 *** -0.92 0.40 ***

Note: Adjusted models control for: spousal education, spousal age, physician age, if spouse is a physician, hours spouse works for pay and spousal earned income.***p<.001, **p<.01 *p<.05R2 approximately .06

Male Physicians Female Physicians

Conclusions: All PhysiciansConclusions: All Physicians

Employment: – The gender difference in employment is VERY

limited. – Most physicians work regardless of gender.

Average Work Week:– The gender difference in average work week is

closing slowly for all physicians. – Women’s work week is coming to more closely

resemble men’s rather than the reverse.

Conclusions: All PhysiciansConclusions: All Physicians Long & Short Work Weeks

– Between 1980 and 2000, the frequency of ‘short’ weeks changed little for men or women.

– The frequency of ‘long’ weeks increased slightly for men and substantially for women.

Location:– Between 1980 and 2000, the gender gap in the odds of

rural practice closed somewhat.– Both the percent of men and the percent of women in

rural areas declined between 1980 and 2000.

Conclusions: Married Conclusions: Married PhysiciansPhysicians

Spousal Employment:– Women physicians’ work effort is more sensitive then

men’s to spousal employment.– Men physicians’ work effort is growing more sensitive

to spousal employment.Spousal Education:

– Women physicians’ location is more sensitive to spousal education.

– Men physicians’ location is growing more sensitive to spousal education.

EXTRA SLIDESEXTRA SLIDES

Figure 1: The Percent of Figure 1: The Percent of Physicians <65 Reporting Physicians <65 Reporting

EmploymentEmployment

98% 98% 98%95% 97% 94%

0%

20%

40%

60%

80%

100%

120%

1980 1990 2000

Men

Women

98% 99% 97%

Figure 2: The Average Work Figure 2: The Average Work Week for Employed Week for Employed Physicians < Age 65Physicians < Age 65

5254 55

4546

49

0

10

20

30

40

50

60

1980 1990 2000

Men

Women

85% 86% 89%

The Percent of Employed The Percent of Employed Physicians <65 Working <35 Physicians <65 Working <35

Hours Per WeekHours Per Week

3% 3% 3%

15% 15%16%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

1980 1990 2000

Men

Women

Figure 4: The Percent of Figure 4: The Percent of Employed Physicians <65 Employed Physicians <65

Working 50+ Hours Per WeekWorking 50+ Hours Per Week

68%

73% 72%

37%

45%

51%

0%

10%

20%

30%

40%

50%

60%

70%

80%

1980 1990 2000

Men

Women

The Percent of Employed The Percent of Employed Physicians <65 Living Outside of Physicians <65 Living Outside of

a Metro Areaa Metro Area

18%

20%

16%

11%

15%

12%

0%

5%

10%

15%

20%

25%

1980 1990 2000

Men

Women

61% 76% 74%

The Percent of Employed The Percent of Employed Physicians <65 who are Physicians <65 who are

Married with Spouse PresentMarried with Spouse Present85% 85%

82%

66%69% 69%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

1980 1990 2000

Men

Women