Physician Gender, Physician
Marriage and the Supply and
Distribution of Medical
Services
Ann Boulis
Ideas and Research on
Gender and Medical Service
Supply & Distribution
1.
2.
3.
Women physicians work less.
Women physicians are less likely to live in
metropolitan areas.
The unique behavior of women physicians
stems from their unique approach to work
and family.
Key Articles

Cull, 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 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 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
Physicians Reporting
Employment
1.20
1.00
.98
1.00
0.96
0.94
0.95
0.95
.98
0.95
0.93
0.80
Men
0.60
Women
0.40
0.20
0.00
1980
1990
2000
Figure 2: The Average Work
Week for Employed
Physicians
60
.86
51
.88
52
53
.92
48
50
44
46
40
Men
30
Women
20
10
0
1980
1990
2000
Figure 3: The Percent of
Employed Physicians Working
<35 Hours Per Week
20%
18%
2.42
17%
2.00
2.00
16%
16%
16%
14%
12%
Men
10%
8%
8%
8%
7%
6%
4%
2%
0%
1980
1990
2000
Women
Figure 4: The Percent of
Employed Physicians Working
50+ Hours Per Week
70%
.60 .60
63%
65%
.74.74
65%
.77.77
60%
50%
50%
44%
40%
38%
Men
Women
30%
20%
10%
0%
1980
1990
2000
Figure 5: The Percent of
Employed Physicians in NonMetropolitan Areas
25%
.63
.75
.73
20%
20%
19%
16%
15%
15%
12%
12%
Men
Women
10%
5%
0%
1980
1990
2000
Figure 6: The Percent of
Employed Physicians who are
Married
0.90
0.85
0.85
.76
0.80
0.70
.81
0.68
0.65
0.83
.82
0.68
0.60
0.50
Men
Women
0.40
0.30
0.20
0.10
0.00
1980
1990
2000
Figure 7: Female/Male
Average Work Week by
Marital Status
1.00
0.98
0.95
0.94
0.95
0.90
0.89
0.86
0.85
0.83
0.80
0.75
1980
Married Female/Male Work Week
1990
2000
Unmarried Female/Male Work Week
The Effect of Spousal Employment on
the Average Weekly Work Week for
Employed Married Physicians
Male Physicians
Unadj
Adj
Models
Models
1980
1990
2000
1.12 ***
2.31 ***
1.59 ***
-0.92 *
-1.54 ***
-2.25 ***
Female Physicians
Unadj
Adj
Models
Models
2.72
1.68
-1.13
-4.58 *
-8.38 ***
-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
The Effect of a Having a Spouse with a NonMedical Graduate
Degree on Locating Outside Metro Area
Male Physicians
Unadj
Adj
Models Odds
Models Odds
B Ratio
B Ratio
1980
1990
2000
-0.36 0.70 ***
-0.47 0.63 ***
-0.63 0.54 ***
-0.27 0.76 ***
-0.43 0.65 ***
-0.59 0.55 ***
Female Physicians
Unadj
Adj
Models Odds
Models Odds
B Ratio
B Ratio
-0.75 0.47 *
-0.99 0.37 ***
-1.08 0.34 ***
-0.74 0.48 ***
-0.94 0.39 ***
-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<.05
R2 approximately .06
Conclusions: 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 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
Physicians

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 SLIDES
Figure 1: The Percent of
Physicians <65 Reporting
Employment
120%
100%
99%
98%
98%
95%
98%
97%
97%
98%
94%
80%
Men
60%
Women
40%
20%
0%
1980
1990
2000
Figure 2: The Average Work
Week for Employed
Physicians < Age 65
60
85%
52
86%
54
89%
55
49
50
45
46
40
Men
30
Women
20
10
0
1980
1990
2000
The Percent of Employed
Physicians <65 Working <35
Hours Per Week
18%
16%
16%
15%
15%
14%
12%
10%
Men
Women
8%
6%
4%
3%
3%
3%
2%
0%
1980
1990
2000
Figure 4: The Percent of
Employed Physicians <65
Working 50+ Hours Per Week
80%
73%
70%
72%
68%
60%
51%
50%
40%
45%
Men
37%
Women
30%
20%
10%
0%
1980
1990
2000
The Percent of Employed
Physicians <65 Living Outside of
a Metro Area
25%
61%
20%
76%
74%
20%
18%
15%
16%
15%
12%
11%
Women
10%
5%
0%
1980
Men
1990
2000
The Percent of Employed
Physicians <65 who are
Married with Spouse Present
90%
85%
85%
82%
80%
70%
66%
69%
69%
60%
50%
Men
Women
40%
30%
20%
10%
0%
1980
1990
2000