Female Physician, Better Care? Provocative New Study Suggests Men and Women Practice Different Medicine

Do men and women practice medicine differently? A new study suggests the answer is most definitely yes, and it also reveals that those differences can benefit patients of female physicians in the form of fewer deaths and hospital readmissions.

The findings, published online earlier this week in JAMA Internal Medicine, provide insight into patterns of care and bolster mounting evidence that the gender of the treating physician has considerable influence.

“Our study adds that these variations in practice patterns between men and women doctors, which have been reported in other studies, result in meaningful differences in outcomes and [shows] that we have to think seriously about why this is happening,” lead author Yusuke Tsugawa, MD, MPH, PhD (Harvard T. H. Chan School of Public Health, Cambridge, MA), said in an interview with TCTMD.

Tsugawa and colleagues analyzed a random sample of 1,583,028 Medicare patients who were hospitalized between 2011 and 2014 for eight different medical conditions and were treated by an internist. Among the most common conditions were congestive heart failure, sepsis, and pneumonia.

Compared with patients of male physicians, those cared for by female physicians had lower adjusted 30-day mortality (11.07% vs 11.49%) and lower 30-day readmission rates (15.02% vs 15.57%; P < 0.001 for both).

“Although the difference in patient mortality between male and female physicians was modest, an observed effect size of a 0.43-percentage-point difference or a relative risk reduction of 4% in mortality is arguably a clinically meaningful difference,” Tsugawa and colleagues write. Extrapolating, they estimate that approximately 32,000 fewer patients would die annually in the United States if male physicians could achieve the same outcomes as their female peers.

Their study builds on prior evidence that female physicians are more likely than their male colleagues to adhere to clinical practice guidelines and that they’re more apt to offer more preventive care, patient-centered communication, and psychosocial counseling. At least one study also has shown that patients of female primary care physicians have fewer emergency department visits than patients of male primary care physicians, the researchers note.

“I think it is possible that it may not be one clinical practice thing that explains the difference,” Tsugawa said. “It may be a combination of all these differences and when you add them all up they result in the findings that we showed.” 

The next step, he added, will be trying to understand the determinants of better quality care from learning how these doctors practice. “This is research that will be really helpful for society and for the healthcare system to make sure that all Americans are getting high-quality medical care,” Tsugawa said.

Call for Cooperation and Change

Commenting on the research for TCTMD, Cindy L. Grines, MD (Detroit Medical Center, Detroit, MI), called the study “intriguing” and said it should be taken seriously, since even modest reductions in mortality are important, as are the reductions seen in readmission across all diagnoses. 

But, she added, getting to the bottom of the differences between male and female physicians may be tricky. 

“We already know women spend more time with patients, and this actually harms their career and salary, which is often RVU-based. Many female physicians I know state that they always [feel] pressured to be faster and more productive,” Grines observed. “When reimbursement becomes quality-based, not volume-based, I think that physicians will take the time to be more thoughtful and analytic.”

Tsugawa said he is hopeful that there may be opportunities for physicians to learn from each other, rather than seeing the issue as a battle of the sexes.

“If they practice the exact same way, gender cannot affect patient outcomes,” he observed. “If they sit together and discuss it, they may find out more about how they do things differently and why those things result in a patient outcome that is better.”

In an editorial accompanying the study, Anna L. Parks, MD, and Rita F. Redberg, MD (University of California San Francisco), say the findings that women provide higher quality care “yet are promoted, supported, and paid less than male peers in the academic setting should push us to create systems that promote equity in start-up packages, career advancement, and remuneration for all physicians.”

To TCTMD, Tsugawa echoed these sentiments, saying his group’s findings raise questions as to whether the professional disparities are “justifiable in any way.”