Podcast Summary: You Are Not Broken

Host: Kelly Casperson, MD

Episode 330: "Does Your Physician's Gender Matter?" (August 10, 2025)

Guest: Dr. Christopher Wallace, Urologic Oncologist & Lead Researcher on Gender-Based Outcomes in Medicine

Episode Overview

This episode dives into groundbreaking research exploring whether the gender of your physician—or more specifically, your surgeon—can affect your health outcomes. Dr. Kelly Casperson interviews Dr. Christopher Wallace, a Toronto-based urologic oncologist and the lead author behind landmark studies showing that patient outcomes, including mortality rates after surgery, vary depending on the sex of both the doctor and the patient. Together, they break down the data, discuss the implications within medicine and society at large, and share insights for both medical professionals and the public.

Key Discussion Points and Insights

The Data: Does Surgeon Gender Matter?

• Main finding: Patients of female surgeons are less likely to die or suffer complications after surgery compared to those treated by male surgeons.
  • "Patients are less likely to die when their surgeon's a woman. One study showed 30 day mortality was 12% lower for patients treated by female surgeons." (00:38, Dr. Casperson)
• These findings are consistent across:
  • Multiple countries (e.g., Canada, US)
  • Millions of surgeries and vast datasets
  • Various surgical specialties
• Similar trends are seen in anesthesiology and other medical fields, not just surgery.
• Meta-analyses consistently show about a 5% reduction in 30-day post-surgery mortality with female surgeons. (03:25)

Origins and Validation of the Research

• Dr. Wallace started this line of research during his residency, initially hypothesizing there would be no gender-based difference. However, results repeatedly contradicted that assumption.
  • "My theory was...that there was no difference...But by the third paper, it was a consistent trend. And so it doesn't surprise me any longer when we see these results." (05:04, Dr. Wallace)

Explanations and Hypotheses

• Notable Explanations:
  • Communication style differences, patient optimization, and risk stratification may play major roles.
  • Women in medicine face greater barriers to entry, possibly resulting in only "exceptional" women surviving the rigors of surgical careers—akin to an "Army Rangers" filtering effect. (12:00–13:30)
  • Socialization and unconscious bias affect medical training and practice.
• "I fundamentally don't believe it's the presence or absence of a Y chromosome that affects a patient." (06:57, Dr. Wallace)

Reactions Within the Medical Community

• Women surgeons feel validated by the data.
• Male surgeons are either receptive and introspective, or defensive—often invoking concerns about "residual confounding" or downplaying findings.

How Gender Bias Manifests in Referrals & Reputation

• Female surgeons get fewer and less straightforward referrals, and are more likely to be penalized professionally after complications—both as individuals and as a group.
  • "If a female surgeon has a bad outcome, all female surgeons in the same specialty in that geographic vicinity will see a decrease in referrals...whereas no effect is observed for the group of male surgeons." (15:35, Dr. Wallace)
• This effect is compared to the "Elizabeth Holmes effect" in business, where isolated failures among women get unfairly generalized.

The Double Bind: Performance & Pay

• Female physicians are paid less on average—about $98,000 less per year—even with better outcomes.
  • "At some point, Chris, like, how are you sleeping at night? We pay the best people almost $100,000 a year less..." (25:58, Dr. Casperson)
• Many of the practices correlated with better outcomes (longer patient time, more thorough care) contribute to women earning less by volume-based compensation models and leave them more vulnerable to burnout and attrition.
• Even at the administrative level (deans, chairs), women are still systematically underpaid.
  • "There is no output metric or quality metric you can come up with that obliterates the pay divide." (29:25, Dr. Wallace)

Electronic Medical Record (EMR) and Unpaid Labor

• Female physicians receive 20–40% more EMR messages than male peers, further increasing their unpaid workload. (29:35–29:52)
• Patients interrupt, question, and expect more emotional labor from female physicians, adding to work complexity and stress.

Biases in Patient Satisfaction and Institutional Metrics

• Press Ganey Scores (patient satisfaction): Women have to invest more time to achieve the same scores as men; these ratings are often tied to salary.
  • "In order to maintain equivalent scores, they have to put in substantially more time and effort to get to the same place." (32:58, Dr. Wallace)
• These metrics are both gender and racially biased, compounding pay disparities.

The Myth of Meritocracy

• Many men in medicine believe in a pure meritocracy, failing to recognize inherent biases in opportunity and recognition, such as exclusion from conference panels and unequal introductions at professional events. (35:08–36:19, 20:42)

Two Layers of Pay Bias

• Female physicians not only earn less for the same work but also tend to do more lower-paid procedures (often for female patients), resulting in a "double bias."
  • "For the average female physician, it’s actually a bit worse than you would expect from just the standard gender-based pay gap for the same work." (38:41, Dr. Wallace)

Systemic Issues and Societal Impacts

• Trends in medicine reflect broader societal inequality, not just a problem within healthcare.

Notable Quotes & Memorable Moments

• "Our work is essentially like an ink block test, particularly for male surgeons, which is to say that what you see as you read our papers says much more about who you are than what the paper itself says."
  —Dr. Wallace quoting Tom Verghese (05:54)
• "The bigger issue...bad outcomes for women get generalized. For men, they don’t." (15:35, Dr. Wallace)
• "The thing is, probably a lot of the behaviors that female physicians exhibit that lead to better outcomes actually harm them professionally." (26:47, Dr. Wallace)
• "If women actually spend the same amount of time with their patients as men do, as physicians, their patient satisfaction scores, their Press Ganey scores are substantially lower." (32:58, Dr. Wallace)
• "There’s too much in medicine this philosophy that like, I had it shitty, so you have to have it shitty too." (46:51, Dr. Wallace)
• "We focus heavily on the medical profession. But...this is a microcosm for society." (47:53, Dr. Wallace)

Actionable Advice & Takeaways

For Physicians:

• Institutions must work to recruit, retain, and support women in surgery and in medicine overall.
• Behaviors leading to better outcomes (e.g., thoroughness, patient communication) should be studied and taught for universal adoption.
• Male physicians should transparently share compensation data with female colleagues to support fair negotiations.
  • "The more we share amongst ourselves, the less likely it is that people are going to get singled out and get taken advantage of." (45:50, Dr. Wallace)

For Patients:

• Realistically, not everyone can choose a female surgeon—there aren’t enough.
• Most important: Find a surgeon or doctor with whom you feel a strong sense of communication, understanding, and trust.
  • "This is about communication. This is about understanding patients’ priorities...You want to find a surgeon who jives with you and can embody those sort of behaviors." (43:01, Dr. Wallace)

For Female Physicians Negotiating Salary:

• Recognize systemic bias is real—don’t assume meritocracy will protect you.
• Seek out and build alliances with supportive male colleagues to strengthen bargaining positions.

Important Timestamps

• 00:38 – Introduction of key findings (lower mortality with female surgeons)
• 03:25 – Meta-analyses and expanding research beyond surgery
• 06:57 – Why gender differences likely aren't biological
• 14:55 – Female surgeons penalized more for complications (referrals research)
• 21:22 – Impact of physician & patient sex concordance/discordance
• 25:58 – Female physicians paid substantially less despite better outcomes
• 29:35 – EMR burden and nurse/patient communication
• 32:58 – Press Ganey/Patient satisfaction bias
• 38:41 – Double bias: women’s pay + female-focused procedures
• 40:00 – Short- and long-term recommendations for physicians
• 43:01 – Advice for patients seeking care
• 44:23 – Salary negotiation advice for female physicians
• 46:51 – The need to reshape the culture of medicine

Tone and Atmosphere

Combining data-driven discussion with candor, reflection, and moments of humor, the conversation is passionate, accessible, and unflinchingly honest about the challenges and inequities women face in medicine—and why the implications go far beyond the hospital. Both host and guest urge listeners to look beyond statistics and think critically about culture, communication, and what we value in healthcare and society.

For more episodes, resources, and classes, visit: kellycaspersonmd.com