Aubree Goodman, DO¹; Sallie Canumay, DO; Matthew Perera, DO, MS¹; Blake Han, BA¹; Christopher Baker, DO¹; Tiffany Lubrino, MS²; John Schlechter, DO^1,2
1Department of Orthopedic Surgery, Riverside University Health System, Moreno Valley, CA,
USA
²Rady Children’s Health Orange County, Orange, CA, USA

ABSTRACT

Background
After discharge following orthopedic surgery, patients or their families may develop concerns or questions that they wish to communicate with an expert physician. Despite the importance of these interactions, it is unclear whether physician gender influences patient and guardian preferences in orthopedic practice, particularly in the pediatric setting.

Methods
This prospective observational study was performed at two pediatric trauma centers, including one Level I and one Level II pediatric trauma center. Inclusion criteria consisted of children aged 3–18 years old presenting for an isolated fracture of the upper or lower extremity that was managed operatively. Operative fracture patients were selected because they undergo standardized postoperative follow-up and commonly require communication with the treating orthopedic team after discharge. Children with non-operative fractures or polytrauma were excluded. The study was conducted over an approximate two-year period from July 2024 to June 2026. A parent or guardian of each child completed a six-item survey regarding their preference for either a male or female physician contact for post-discharge concerns.

Results
A total of 36 children and their parents or guardians were included in this study. Twelve children were enrolled at the level II trauma center and 24 at the level I trauma center. Participants were 61.1% male and 38.9% female, with an average age of 10.0 ± 4.6 years. The mean age of parents or guardians was 41.4 ± 8.3 years, and most respondents were mothers (72.2%) and female (72.2%). Nearly all respondents reported no physician gender preference following discharge (35/36, 97.2%). Only one respondent (2.8%) preferred a female physician, and no respondents preferred a male physician. 

Conclusions
This hypothesis-generating study found that nearly all parents and guardians reported no physician gender preference for post-discharge communication. However, these findings should be interpreted as exploratory because of the small sample size and low frequency of gender preference responses, and further research with a larger, adequately powered sample is needed to better characterize whether physician gender influences parent and guardian decision-making, comfort, and willingness to contact physicians with concerns or clarification after discharge.

Keywords: Parent; guardian; gender; discharge

INTRODUCTION

After discharge following orthopedic surgery, patients or their families may have concerns or questions that they wish to communicate with an expert physician. Addressing these concerns may identify those with evolving postoperative complications, reduce unnecessary emergency department visits, or provide timely reassurance and guidance. These interactions are an important part of postoperative care and can influence guardian satisfaction, understanding of discharge instructions, adherence to treatment recommendations, and healthcare utilization. Despite the importance of these interactions, it is unclear whether physician gender influences patient and guardian preferences in orthopedic practice, particularly in the pediatric setting.

Patients generally prefer physicians with a patient-centered style of communication, and research suggests that women employ these techniques more than men [1]. It has been suggested that several implicit biases exist as they relate to gender roles, with men typically being characterized as more assertive, aggressive, and self-reliant in communication, whereas women are considered to be more interpersonally competent, nurturing, empathetic, caring, and easier to talk to [2,3]. Such stereotypes, whether conscious or not, may contribute to the comfort patients may have when communicating with physicians of different genders [2]. Competent communication skills are associated with several positive outcomes, including patient satisfaction, adherence to recommendations, improved physiological indicators of disease control, and enhanced physical and mental health status [4]. Therefore, patient perceptions of gender in medical professionals and their associated perceived communication skills should not be overlooked as they have the ability to influence patient outcomes. 

In this prospective observational study, we sought to determine whether the parents and guardians of children undergoing orthopedic procedures demonstrate a preference for male versus female physician contact for post-discharge-related concerns. We hypothesized that there would be a slight preference for female physician contact, although any preference would likely be minimal.

METHODS

Study Design
This prospective observational study was performed at two pediatric trauma centers, including one Level I and one Level II pediatric trauma center. The study received Institutional Review Board approval, and written informed consent was obtained from the patient regarding participation in and publication of this study. Inclusion criteria consisted of children aged 3–18 years old presenting with an isolated fracture of the upper or lower extremity that was managed operatively. Operative fracture patients were selected because postoperative fracture care involves standardized follow-up and provides a consistent clinical setting in which parents and guardians commonly communicate with the treating orthopedic team after discharge. Children with non-operative fractures or polytrauma were excluded. The study was conducted over a two-year period from July 2024 to June 2026. 

Data Collection
Baseline patient characteristics, including age, sex, race, and ethnicity, were collected from the electronic medical record. A parent or guardian of each child completed a six-item survey to be filled out based on the respondent’s information:

1. Please indicate your relationship to the patient (e.g., father, mother, other).
2. What is your age in years?
3. Please indicate your race and ethnicity.
4. How do you describe yourself (e.g., male, female, transgender, nonbinary, prefer not to answer)? 
5. If you have questions for the physician after discharge, would you prefer to speak with a physician that identifies as female or male?
6. How strongly do you feel about your preference to the prior question?

The gender of the research personnel responsible for obtaining consent and communicating with the parent or guardian was also recorded.

Statistical Analysis
Descriptive statistics were calculated, including mean ± standard deviation and frequencies and percentages. Cramer’s V was calculated as a measure of effect size for the association between respondent sex and physician gender preference. Power analyses and sample size calculations were performed using G*Power (version 3.1.9.6; Heinrich Heine University Düsseldorf, Düsseldorf, Germany).  

RESULTS

A total of 36 children and their parents and guardians were included in this study. Twelve children were enrolled at the level II trauma center and 24 at the level I trauma center. Participants were 61.1% male and 38.9% female, with an average age of 10.0 ± 4.6 years. Patient demographic and clinical characteristics are presented in Table 1. 

Table 1. Patient Demographics and Characteristics (N = 36)

Note: Data presented as N = 36.

A total of 36 parents or guardians completed the survey. The mean respondent age was 41.4 ± 8.3 years, and most respondents were mothers (72.2%) and female (72.2%). The majority identified as White (80.6%) and non-Hispanic (55.6%) (Table 2). 

Table 2. Parent and Guardian Respondent Characteristics (N = 36)

Nearly all respondents reported no physician gender preference following discharge (35/36, 97.2%). Only one respondent (2.8%) preferred a female physician, and no respondents preferred a male physician. When asked about the strength of their physician preference, 25 respondents (69.4%) reported a mild preference, 2 (5.6%) reported a moderate preference, and 9 (25.0%) reported a strong preference (Table 3).

Table 3. Physician Gender Preference and Strength of Preference Among Parent or Guardian Respondents (N = 36)

DISCUSSION

In this study, 35 of 36 (97.2%) parents or guardians reported no preference regarding the gender of the physician contacted after discharge. The only respondent who expressed a preference of physician gender was the mother of a 13-year-old male patient, who reported a strong preference for a female contact. Notably, the patient was consented by a male investigator. Given that only one respondent expressed a physician gender preference, no meaningful conclusions can be drawn regarding factors associated with this preference.

Our findings are generally supported by the current literature, which demonstrates little to no differences in patient preference or satisfaction by gender. Although orthopedic surgery is consistently identified as the medical specialty with the least gender diversity in the United States, with women comprising only approximately 7–8% of practicing orthopedic surgeons and ~20% of orthopedic surgery residents [5,6], a study of 393 patients found that the gender of the treating orthopedic surgeon was of low importance to both male (1.58 of 10) and female (2.15 of 10) patients, with slightly more consideration given by female patients [7]. A comparison of satisfaction scores across 7,856 patients treated by 62 orthopedic surgeons found that female surgeons had higher satisfaction scores, although this relationship was not preserved in multiple linear regression analysis [8]. In contrast, slightly older literature demonstrated lower odds of receiving a 5-star Press Ganey rating in female orthopedic surgeons [9].

In the broader medical literature, an analysis of over 82,000 outpatient visits found that female physicians received higher patient experience scores in surgical specialties compared to their male counterparts [10]. However, gender concordance may influence these metrics to a greater extent than gender alone. Esposito et al. demonstrated in a systematic review that gender concordance was associated with improved metrics in communication and trust, with these results more prominent amongst female–female interactions as compared to male–male [11].

Despite the lack of significant findings in post-discharge physician gender preference, there remain several possible explanations for why gender preference may not be neutral and why a true difference may exist. Female physicians tend to have longer encounters with patients [4], and achieve more positive outcomes through nonverbal communication [12]. In contrast, male physicians’ visits obtain more favorable patient outcomes primarily through verbal communication [12].

Limitations
This study has several limitations. First, this study enrolled a relatively small sample and was not adequately powered to detect uncommon physician gender preferences. Consequently, these findings should be interpreted as exploratory rather than definitive. Based on an interim analysis of 36 participants, the observed effect size for physician gender preference was Cramer’s V = 0.105 (df=2), corresponding to an observed power of 8.1% at α = 0.05. Using this observed effect size, a total sample size of approximately 874 participants would be required to achieve 80% power for a chi-squared test at α=0.05. However, this estimate should be interpreted cautiously, as the effect size was derived from a small interim sample and may not reflect the true population effect. Second, the majority of the patients were consented by a female member of the research staff, which may have introduced bias towards selecting a female preference or away from selecting a male preference. Third, enrollment was limited to operative fracture patients, which may reduce the generalizability of these findings to children with nonoperative injuries or other pediatric orthopaedic conditions. Further research is required to determine the true nature of preference, by assessing whether patients selectively contact a male versus female in their immediate post-discharge recovery period. This study was also not designed to determine whether alignment between preferred physician gender and actual physician gender influenced post-discharge call frequency, patient satisfaction, comfort with contacting physicians, or clinical outcomes.

Conclusion
This hypothesis-generating study suggests that parents and guardians may not have a preference for male versus female post-discharge contact. However, these findings should be interpreted as exploratory because of the small sample size and low frequency of gender preference responses, and further research with a larger, adequately powered sample is needed to better characterize whether physician gender influences parent and guardian decision-making, comfort, and willingness to contact physicians with concerns or clarification after discharge.

ETHICAL AND TRANSPARENCY STATEMENTS

IRB/Ethics approval or exemption
This study was approved by the Institutional Review Board of both participating organizations (2231935-11 and 2306733-3)

Consent to participate (or waiver)
Written informed consent was obtained for participation.

Consent for publication (required for case reports and identifiable images)

Written informed consent was obtained for publication.

Conflict of Interest statement
No conflicts of interests to disclose.

Funding statement
No funding was received for this work.

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