Seen and Heard: Gender Identity and Concordance Shapes Caregiver Experiences in Pediatric Orthopaedics

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ABSTRACT Background Pediatric care poses unique challenges in communication and ensuring satisfaction as parents/caregivers are often the primary decision makers. Previous studies have explored the influence of physician and patient race, ethnicity, and gender on clinical encounters. We aimed to examine the impact of physician and caregiver gender on caregiver satisfaction during pediatric orthopaedic clinic visits. Methods Anonymous surveys were distributed to caregivers following visits with nine pediatric orthopaedic surgeons (six male, three female) at two tertiary-care children’s hospitals from 2022-2024. Surveys included 16 questions across 5 domains sourced from the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey (four-point Likert scale). Caregivers also provided an overall physician rating (scale of 10), and demographic data. Surveys were designated as concordant or discordant (same or different caregiver-physician gender). Responses were analyzed by gender and between matched concordant-discordant visits. Validated measures and numerical scores were compared using Mann-Whitney U tests. Non-validated questions were compared using Fisher’s tests. Results Overall, 482 surveys were completed, the majority by female caregivers (N=353, 73%); male caregivers (N=129, 27%). Household incomes differed significantly with most female caregivers reporting an annual income between $25,000-50,000, while most males reported greater than $100,000 (p<0.001). Overall, caregivers rated their physician highly with no significant difference between genders. Significantly more female caregivers negatively perceived physician listening quality and time spent with their child (p=0.03 and 0.02, respectively). Female caregivers felt less involved in decision-making than male caregivers (p=0.04). Analysis of 376 surveys matched by gender demonstrated that discordant encounters had a significantly higher rate of dissatisfaction (4% versus 1%) regarding discussion of care options and involvement in decisions compared to concordant visits (p=0.02 and 0.04, respectively). There was also a significant difference (p<0.01) in satisfaction between concordant and discordant visits when addressing questions. Conclusion Overall, caregivers were satisfied with their experience. However, female caregivers reported lower satisfaction with physicians in several domains compared to males. Gender concordance improved patient satisfaction in these domains, supporting the need for improved representation of women in orthopaedic surgery. Level of Evidence IV Key Concepts 1. Caregiver satisfaction was high overall in the ambulatory setting for pediatric orthopedic surgery 2. Caregiver/physician gender concordant clinical encounters resulted in higher reported satisfaction compared to discordant encounters 3. Surgeons should focus on empathetic listening, understanding the impact of the condition on the patient, and the nuances of surgical discussion to build rapport and improve caregiver satisfaction. 4. Continued efforts are needed to achieve a demographic of pediatric orthopedic surgeons that is reflective of the community and patient population at large

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