Anesthesiologist Age and Sex Influence Patients: Reply

We appreciate Wang et al.¹  for their interest in our work. We studied the effects of anesthesiologist age and sex on patient perceptions of the anesthesiologist’s confidence, intelligence, likelihood of choosing the anesthesiologist to care for a family member, and leadership abilities. In our study,²  300 patients were randomized to view a set of four videos in random order, each featuring an anesthesiologist varying in sex (female or male) and age (younger or older). All anesthesiologists displayed confident, high-power body language. In brief, we found that patients ranked female anesthesiologists higher than male anesthesiologists on the measures of confidence and likelihood of choosing the anesthesiologist to care for a family member and younger patients (younger than 65 yr old) ranked older anesthesiologists higher than younger anesthesiologists on the measures of confidence, intelligence, and leadership abilities. We would like to address both points of concern regarding our findings and statistical analysis that were raised by Wang et al.¹ 

First, Wang et al. may have overlooked the power analysis and sample size estimation in our paper. In fact, the power analysis was performed a priori as noted in the statistical analysis section of our paper. Our power analysis revealed that enrolling 300 participants would provide more than 80% power to detect a difference in ranking one half-level or greater by sex, age, and interaction, with adjustment for multiple testing for the three ranked measures (confidence, intelligence, care of family member).

Second, the current study focused on evaluating the effects of sex and age of an anesthesiologist on the anesthesiologist’s perceived competence. This study was designed notably different from our previous study³  that evaluated the effects of anesthesiologist body language and sex on patient perceptions of anesthesiologist competence. Indeed, our previous study did not detect a difference in patient perceptions related to sex of the anesthesiologist, but did detect a preference for anesthesiologists displaying confident, high-power body language (rather than unconfident, low-power body language) on all four measures of anesthesiologist competence. In the current study, we removed body language as a variable by having all actors demonstrate confident, high-power body language. By removing this variable, we were able to detect a difference in patient preferences related to the sex of the anesthesiologist. This does not make our results “unstable” as suggested by Wang et al.,¹  rather, it reveals that there is a hierarchy of anesthesiologist characteristics to which patients respond. That is, an anesthesiologist’s body language may weigh more heavily upon a patient’s perception of an anesthesiologist’s confidence and competence. Once over this hurdle, some patients would perceive the competence differently according to the anesthesiologist’s sex and age. In future studies, it would be interesting to investigate this hierarchy of anesthesiologist characteristics further. Again, we appreciate the concerns of Wang et al., but we can reassure the readers that appropriate statistical considerations were taken in our study.

Dr. Forkin receives funding from Hemosonics, LLC (Charlottesville, Virginia) for research unrelated to this work. The remaining authors declare no competing interests.