Picture a surgeon. Let’s see: light blue scrubs; scrub cap; blue surgical mask; steady hands; perhaps a tight ponytail tucked into the surgical cap? Or maybe in a lab coat, with stethoscope draped around their neck, a confident and reassuring smile, and a clean-shaven, strong jaw? We want to feel confident that whomever is cutting open our delicate tissues knows precisely what they are doing, and knows how to act quickly if something goes wrong. So: what does your surgeon look like? What is your surgeon’s sex?

Does it matter? Well, apparently to referring physicians it does tend to matter. A recent analysis of forty million physician referrals to surgery over a twenty-year period resulted in some interesting, and troubling, findings.

The purpose of the study was to follow up on other studies that revealed that female surgeons have fewer opportunities to perform highly complex – and highly compensated – surgeries. This lack of opportunity contributes to the sex-based pay gap in surgery.

The study evaluated nearly forty million referrals made by 44,893 physicians to 5,660 surgeons. Though male surgeons account for 77.5% of all surgeons, they received 87.1% of referrals from male physicians and 79.3% of referrals from female physicians. And female surgeons receive less procedural referrals than male surgeons. Male physicians – especially surgeons – tend to refer patients more frequently to male surgeons than do female physicians.

Over the past twenty years some progress has been made in highlighting many inequities in medicine; the study has demonstrated, though, that referral preference for male surgeons has not improved with time. This is notable because over those twenty years more women have entered surgery. Yet these biases remain.