Background Online physician reviews are an important source of information for prospective patients. In addition, they represent an untapped resource for studying the effects of gender on the doctor-patient relationship. Understanding gender differences in online reviews is important because it may impact the value of those reviews to patients. Documenting gender differences in patient experience may also help to improve the doctor-patient relationship. This is the first large-scale study of physician reviews to extensively investigate gender bias in online reviews or offer recommendations for improvements to online review systems to correct for gender bias and aid patients in selecting a physician. Objective This study examines 154,305 reviews from across the United States for all medical specialties. Our analysis includes a qualitative and quantitative examination of review content and physician rating with regard to doctor and reviewer gender. Methods A total of 154,305 reviews were sampled from Google Place reviews. Reviewer and doctor gender were inferred from names. Reviews were coded for overall patient experience (negative or positive) by collapsing a 5-star scale and coded for general categories (process, positive/negative soft skills), which were further subdivided into themes. Computational text processing methods were employed to apply this codebook to the entire data set, rendering it tractable to quantitative methods. Specifically, we estimated binary regression models to examine relationships between physician rating, patient experience themes, physician gender, and reviewer gender). Results Female reviewers wrote 60% more reviews than men. Male reviewers were more likely to give negative reviews (odds ratio [OR] 1.15, 95% CI 1.10-1.19; P<.001). Reviews of female physicians were considerably more negative than those of male physicians (OR 1.99, 95% CI 1.94-2.14; P<.001). Soft skills were more likely to be mentioned in the reviews written by female reviewers and about female physicians. Negative reviews of female doctors were more likely to mention candor (OR 1.61, 95% CI 1.42-1.82; P<.001) and amicability (OR 1.63, 95% CI 1.47-1.90; P<.001). Disrespect was associated with both female physicians (OR 1.42, 95% CI 1.35-1.51; P<.001) and female reviewers (OR 1.27, 95% CI 1.19-1.35; P<.001). Female patients were less likely to report disrespect from female doctors than expected from the base ORs (OR 1.19, 95% CI 1.04-1.32; P=.008), but this effect overrode only the effect for female reviewers. Conclusions This work reinforces findings in the extensive literature on gender differences and gender bias in patient-physician interaction. Its novel contribution lies in highlighting gender differences in online reviews. These reviews inform patients’ choice of doctor and thus affect both patients and physicians. The evidence of gender bias documented here suggests review sites may be improved by providing information about gender differences, controlling for gender when presenting composite ratings for physicians, and helping users write less biased reviews.

BACKGROUND Online doctor reviews are an important information source for prospective patients. In addition, they represent an untapped resource for studying gender bias in the doctor patient relationship. Understanding bias is important because it may impact the value of online reviews to patients. Documenting bias is also important for improving the doctor patient relationship. Yet studies of bias are currently limited to smaller data sets and specific conditions. OBJECTIVE In this research, we explore 154,305 reviews from across the U.S. for all doctor specialties. Our analysis includes a qualitative and quantitative examination of review content and rating as they relate to doctor and reviewer gender. METHODS 154,305 reviews were downloaded from Google. For each review, the reviewer and doctor were assigned a gender based on name. Reviews were also coded by star rating (low or high) and content category (process, positive soft skills, negative soft skills). Our quantitative analysis made use of regression to model the relationships between the variables of interest (process, soft skills, physician gender, and reviewer gender). RESULTS Reviews for female physicians were overall significantly more critical (3.4 average rating for female and 4.0 average rating for male physicians). Reviews for female physicians were significantly more critical with respect to both process and soft skills, with negative comments on soft skills being twice as common for female (16.02%, 5,903 of 36,847) as for male physicians (8.80%, 6,529 of 74,189). Reviewer gender was not a strong predictor of review outcome or content, in general (p=0.046). The largest difference is in mentions of negative soft skills; 8.81% of female reviewers (5,978 of 67,857) and 7.79% of male reviewers (3,364 of 43,179). However there is a significant interaction effect between reviewer and physician gender. Female reviewers rate male physicians positively around 75.90% of the time (33,466 of 44,094), while male reviewers rate female physicians positively around 58.19% of the time (7,362 of 12,652). Our approach cannot identify causal relationships. CONCLUSIONS Reviews for female physicians were more critical and focused more on soft skills than reviews for male physicians. Additionally, female reviewers are more likely to report on positive interpersonal skills than are male reviewers, and more likely to report experiences of disrespect and indifference in negative reviews than are male reviewers. This work complements existing smaller-scale studies of bias and suggest a need to include information about gender differences in review site summaries and search results. CLINICALTRIAL N/A