Patient gender preferences in neurosurgical care: A cross-sectional study with operational modelling

Physician gender may influence patient comfort and communication dynamics in clinical encounters. However, empirical evidence on physician-gender preferences in procedural, high-technology specialties such as neurosurgery remains limited, particularly in outpatient care.

What is the prevalence of physician-gender preferences among neurosurgical outpatients across clinical scenarios, which factors are associated, and what are the operational implications?

We conducted a cross-sectional survey of 324 adult neurosurgical outpatients at a German university hospital. Respondents reported physician-gender preferences across five scenarios: consultation, examination, minor intervention, major operation, and disclosure of bad news. Multivariable logistic regression assessed demographic, clinical, and affective associations. Monte Carlo simulations estimated preference fulfilment under varying physician gender ratios.

Between 32.7% and 48.1% of respondents reported a physician-gender preference. Directional preferences were evenly split between female and male physicians. Demographic factors, education, and disease category showed no consistent associations. Symptom-related worry increased preference expression for minor interventions (OR 1.65, 95% CI 1.03-2.66) but reduced it for major operations (OR 0.58, 95% CI 0.36-0.94). Male patients were less likely to express preferences in operative settings (OR 0.55, 95% CI 0.34-0.89). Simulations showed that altering workforce gender ratios changed fulfilment rates by less than two percentage points.

Physician-gender preferences are common but balanced and weakly associated with patient characteristics. Emotional context rather than physician gender drives preference expression. Adjusting workforce composition offers minimal benefit; attention to situational anxiety and high-quality communication is more impactful for patient-centred neurosurgical care.