Some previous studies have suggested that female physicians may provide higher quality medical care, but patient outcomes have never been investigated. New research aims to fill this research gap by examining whether patient outcomes are different for those treated by male and female doctors, respectively.
A team of researchers, from Harvard T.H. Chan School of Public Health in Boston, MA, set out to see if potential gender differences in clinical practice had an impact on patient clinical outcomes.
The authors were motivated by previous research, which suggested that male and female physicians differed in their medical practice. For instance, female physicians tend to adhere to clinical guidelines more strictly, provide more preventive care, and use more patient-centered communication than their male counterparts.
Despite this, female physicians are paid significantly less than their male counterparts, with various authors offering different explanations for this pay gap.
In this context, a team of researchers - led by Yusuke Tsugawa, research associate in the Department of Health Policy and Management - decided that an examination of patient outcomes was necessary.
The results were published in the journal JAMA Internal Medicine.
Evaluating the links between patient outcomes and physician gender
Researchers analyzed a 20 percent sample of Medicare Inpatient and Carrier Files, and they identified 1 million beneficiaries aged 65 or older who were admitted to acute care hospitals between January 1, 2011, and December 31, 2014.
The scientists examined associations between the physicians' sex and the patients' 30-day mortality rate (that is, how many patients died within 30 days of admission), as well as their 30-day readmission rate (whether patients were readmitted within 30 days of being discharged.)
To ensure the reliability of the results, Tsugawa and team used three regression models. The first model adjusted for patient characteristics, the second one additionally adjusted for hospital effects, and the third model considered all the variables in models one and two plus physician characteristics.
Researchers also evaluated whether the differences in patient outcomes varied according to the primary condition that a patient was admitted for, as well as the severity of the illness.
Finally, scientists looked at potential mechanisms that could explain the differences they observed. Some of these possibilities included different lengths of stay, use of care, and patient volume.
To account for the possibility that male physicians might be more likely to treat severely ill patients in intensive care units, researchers excluded hospitals with a medical intensive care unit.
Patients treated by women have lower mortality and readmission rates
Tsugawa and team discovered a range of differences between male and female physicians. For instance, female physicians were younger and treated fewer patients than their male counterparts.
More importantly, however, patients cared for by female doctors had a significantly lower 30-day mortality rate than patients treated by male physicians.
Overall, patients treated by female physicians had a 4 percent lower relative risk of dying, and a 5 percent lower risk of being rehospitalized.
The 30-day mortality rate for all the patients was 179,162, or 11.32 percent.
Patients treated by female doctors had a 10.82 percent mortality rate, compared with 11.49 percent of patients treated by male physicians. These differences were little or not at all affected by various adjustments.
The authors point out that while these numbers may seem modest, they translate into a clinically meaningful relative difference.
Patients cared for by female physicians also had significantly lower readmission rates than those with male doctors.
The overall 30-day readmission rate was 237,644, or 15.42 percent. After adjustments for patient characteristics, hospital effects, and physician characteristics, female physicians still had a 15.57 percent readmission rate, compared with 15.01 percent for those with male doctors.
Women may provide better care, but gender discrimination persists
The findings were consistent across a variety of conditions and differences in severity of illness, and they were deemed "surprising" by the researchers.
"The difference in mortality rates surprised us. The gender of the physician appears to be particularly significant for the sickest patients. These findings indicate that potential differences in practice patterns between male and female physicians may have important clinical implications."
According to existing research quoted by the authors, some of the differences in clinical practice include the tendency of female physicians to practice evidence-based medicine, perform just as well or better on standardized tests, and provide more patient-centered care.
Considering evidence from other work industries, the authors hypothesize that men's tendency to take unnecessary risks and be overconfident in their problem-solving abilities may also play a role.
Ashish Jha, director of the Harvard Global Health Institute and senior author of the study, emphasizes that while the causes for their findings remain unknown, they are important for the patients' well-being.
"There was ample evidence that male and female physicians practice medicine differently," Jha says. "Our findings suggest that those differences matter and are important to patient health. We need to understand why female physicians have lower mortality so that all patients can have the best possible outcomes, irrespective of the gender of their physician."
Jha also notes that women doctors tend to be treated differently because of their gender. For instance, they are less likely to be promoted and have lower salaries.