Inequalities in the geographical distribution and workload of obstetrics and gynaecology specialists by gender in Turkey

Background: Women often have a preference for female obstetrics and gynaecology specialists (ob/gyns). Following the policy allowing physician selection by patients in Turkey, distribution of ob/gyns by gender across provinces has been an important indicator of access to healthcare. Aims: To analyse ob/gyns distribution by gender across provinces in Turkey, with emphasis on the relationship with conservativeness of the province and resulting physician workload. Methods: We measured the number of male and female ob/gyns by province in 2016 and the number of outpatient visits and deliveries performed by male and female ob/gyns in 2015. Pearson and Spearman correlation of the female ratio with votes for conservative parties was used to assess the distribution of ob/gyns. We then analysed the correlation with resulting workload of female ob/gyns and ran linear regressions of these variables controlling the number of ob/gyns in a province. Results: More conservative provinces, measured by the vote share for conservative political parties, have a higher ratio of female ob/gyns. Linear regression showed that a 1 percentage point (pp) increase in the vote share corresponded to a 0.69 pp increase in female ratio. For workload, a 1 pp higher female ratio resulted in a decrease in workload, measured as outpatient visits per female ob/gyn divided by that per male ob/gyn, by 0.014. Conclusion: Conservative provinces have more female ob/gyns, but other provinces compensate for that with higher female ob/gyn workload. High workload may have adverse health effects and result in lower quality of care.