Women's provider preferences for basic gynecology care in a large health maintenance organization

To examine women's preferences for the type and sex of the provider of basic gynecological services and the correlates of these preferences, we mailed a cross-sectional survey to 8406 women in a large group model health maintenance organization (HMO) in northern California, with a response rate of 73.6%. Four questions asked women the type (obstetrician/gynecologist, nurse practitioner, or primary care physician) and sex of provider who performed their last pelvic examination and their preferences in type and sex of provider for these examinations. This was a random sample of female HMO members 35-85 years of age who were empaneled with a primary care physician from one of three categories: family practitioner, general internist, or subspecialist. Of the 5164 respondents who received their last pelvic examination at Kaiser Permanente, 56% had seen a gynecologist, 26% a nurse practitioner, and only 18% their own primary care physician for the examination. Of these women, 60.3% reported preferring a gynecologist for basic gynecology care, 12.6% preferred a nurse practitioner, 13.3% preferred their own primary care physician, and 13.8% had no preference. Patients of family practitioners were more likely to prefer their own primary care practitioner than patients of other types of doctors. The strongest independent predictor of preferring a gynecologist over the primary care physician was having seen a gynecologist for the last pelvic examination (OR = 28.3, p < 0.0001). Other independent predictors of preferring a gynecologist were younger age, higher education and income, and having a male primary care physician. Of respondents, 52.2% preferred a female provider for basic gynecological care, and 42.0% had no preference for the sex of the provider. Preferring a female provider was strongly and independently associated with lower income, higher education, nonwhite race, having a male primary care physician, having an older primary care, physician, and having seen a female provider at the last pelvic examination. In this HMO, a majority of women reported a preference for seeing an obstetrician/gynecologist for their routine gynecological care, despite having a primary care physician. This most likely reflects the strong influence of previous patient experience and that familiarity with a particular type of provider leads to preferences for that type. This medical group's structure probably also affects preferences, as in this HMO, primary care physicians can be discouraged from performing pelvic examinations. Many women do prefer female providers for pelvic examinations, but a large percentage have no preference. These women often see male providers for basic gynecological care. As managed care places increasing emphasis on providing integrated, comprehensive primary care, this apparent preference for specialty gynecological care will require further study.