Gendered Expectations: Do They Contribute to High Burnout
Among Female Physicians?
Mark Linzer, MD
and Eileen Harwood, PhD
Division of General Internal Medicine, Office of Professional Worklife, Hennepin County Medical Center, Minneapolis, MN, USA;
School of Public
Health, University of Minnesota, Minneapolis, MN, USA.
Patients have differing expectations of female versus male
listening and longer visits, especially with female physi-
cians; however, female doctors are not provided more time
for this. Female doctors have more female patients than
male doctors, and more patients with psychosocial com-
plexity. We propose that gender differences in patient
panels and gendered expectations of female physicians
may contribute to the high rate of burnout among female
clinicians, as well as to the many female physicians work-
ing part-time to reduce stress in their work lives. We pro-
pose several mechanisms for addressing this, including
brief increments in visit time (20, 30 and 40 min), staff
awareness, training in patient expectations during medical
school, adjusting for patient gender in compensation
plans, and co-locating behavioral medicine specialists in
primary care settings. Beneficial outcomes could include
fewer malpractice suits, greater patient satisfaction, higher
quality care, and lower burnout among female physicians.
KEY WORDS: burnout; disparities; patient satisfaction; physician
J Gen Intern Med 33(6):963–5
© Society of General Internal Medicine 2018
Ann sees Dr. Mary the day she wants to talk about
numerous psychosocial issues; she has several issues to
raise that would require a long visit and would benefit
from empathic listening. Ann is a complex patient with
both medical and psychosocial problems. Dr. Mary
tries to listen, but becomes pressed for time and unfor-
tunately needs to cut Ann off several minutes into the
appointment. Expecting to have had more time with
Dr. Mary, Ann rates her as lacking sufficient listening
skills on the patient satisfaction survey.
Jonathan has a visit with Dr. Dave. He has some
psychosocial issues, but is not eager to bring them up.
Furthermore, he does not expect Dr. Dave to spend
much time listening. The doctor does not ask about the
psychosocial issues. The appointment ends after a few
minutes and Jonathan says nothing about his concerns.
Because his expectations were met during the visit,
Jonathan gives Dr. Dave a good score on the patient
These representational scenarios demonstrate the chal-
lenges for female physicians related to their patients’ gendered
expectations. In general, patients differ by gender in their
expectations regarding doctor-patient relational interactions.
Roter and Hall have shown that patients of female physicians
spoke more during office visits and disclosed more biomedical
and psychosocial issues. Because female physicians also
asked more psychosocial questions, appointment duration
was 10% longer for female physicians compared to males.
Houle, Harwood, and colleagues assessed Bwhat women
want^ during visits with their health care providers.
authors found that women had high hopes for empathic care
that they associated with being listened to. These types of
expectations may have negative consequences that dispropor-
tionately affect female physicians.
Potential Connection Between Burnout and Patient
An early study of physician work-life demon-
strated a 60% excess of burnout in females versus male phy-
sicians. This excess burnout appeared to be driven, in part, by
uneven patient expectations affecting not only office visits, but
also physician work lives and personal wellness.
In this study,
female physicians had more female patients and more patients
with psychosocial complexity; thus, the patients of female
physicians had, on average, different needs (such as gyneco-
logic care and counseling) and required longer visits. In an
experimental design study, female participants were more
likely than males to express satisfaction with their simulated
doctor’s visits when the female physician’s communication
style was caring, while it did not matter whether the male
physician demonstrated a caring communication style.
study of perceived dominance found that both male and fe-
male participants perceive female physicians as dominant,
significantly more so than male physicians, when they sit too
close, speak more and/or loudly, look more often at their
computer, ask too many questions, or disagree with patients.
Cousin and colleagues recently showed that patients toler-
ated expressed uncertainty from their physicians except in
Received September 1, 2017
Revised November 21, 2017
Accepted January 10, 2018
Published online February 12, 2018