An emergency department (ED) physician’s race and sex may not play a significant role in influencing patients’ satisfaction or confidence in provided care, a study in JAMA Network Open suggests.

Researchers constructed a simulated clinical encounter to determine whether a physician’s sex or race affected participant ratings during scenarios in which the competence of the physician is challenged. A geographically diverse sample comprising 3215 online respondents in the United States were enrolled in the study (median age, 49 years [range, 18-89 years]; 76% were white). Participants were exposed to a clinical vignette with a corresponding picture of the ED physician.

The researchers randomly assigned participants to physicians who were black women (n=823), black men (n=791), white women (n=828), or white men (n=835). Skepticism regarding the clinical diagnosis was introduced via a contradictory diagnosis taken from an online symptom checker.

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The primary outcome was a composite that measured participants’ confidence in the physician, satisfaction with care, likelihood to recommend the physician, trust in the physician’s diagnosis, and likelihood to request additional tests. The composite was scored in a range between 0 and 100, with 0 representing low patient confidence and satisfaction and 100 representing a high confidence maximum.

There were no significant differences in participants’ ratings in satisfaction and physician confidence for physicians who were white men (mean composite score, 66.13; 95% CI, 64.76-67.51) vs physicians who were white women (mean composite score, 66.50; 95% CI, 65.19-67.82). In addition, there were no differences between satisfaction and physician confidence ratings among participants who were randomly assigned to physicians who were white men vs physicians who were black women (mean composite score, 67.36; 95% CI, 66.03-68.69) or black men (mean composite score, 66.96; 95% CI, 65.55-68.36).

A primary limitation of the study was the use of written clinical vignettes in hypothetical interactions within the ED, rather than information taken from actual clinical scenarios in which unconscious bias may play a greater role. In addition, the use of only the ED scenario may not provide a generalized understanding of patients’ satisfaction and confidence in other settings.

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The authors of the study wrote that “institutional biases and workplace dynamics, including potential discrimination from leadership, peers, and staff, may play a greater role in the bias experienced by women and minority group physicians in the ED.”


Solnick RE, Peyton K, Kraft-Todd G, Safdar B. Effect of physician gender and race on simulated patients’ ratings and confidence in their physicians: a randomized trial. JAMA Netw Open. 2020;3(2):e1920511.