Are Female Physicians Better Than Male Physicians?

Female hospitalists may facilitate better clinical outcomes

Female doctor meeting with other doctors and nurses
Hero Images/Getty Images

In September 2016, results from a study published in JAMA Internal Medicine showed that women academic physicians at 24 U.S. medical schools made about eight percent less money than their male counterparts do.

More recently, results from another study also published in JAMA Internal Medicine suggest that female internists working in hospital settings (aka hospitalists) are, at least objectively, more successful at treating elderly patients than are their male counterparts.

Taken together the results of these separate studies can be interpreted as follows: There are some female hospitalists out there providing better care than their male counterparts and getting paid less for doing it.

Despite the passage of The Equal Pay Act of 1963, women still make less than men do. Unfortunately, the gender pay gap is nothing new and a sad reality of life that is realized by the vast majority of women who take their first jobs after graduating from college. According to the American Association of University Women (AAUW), “women one year out of college who were working full time earned, on average, just 82 percent of what their male peers earned.”

But the prospect that some women hospitalists could be providing better care than their male colleagues is particularly noteworthy and has existential implications. After all, it’s tempting to think that because men and women are educated and trained at the same medical schools and medical training programs, the care that they provide should be relatively comparable.

However, after adjusting for confounding variables, this doesn’t seem to always be the case, and researchers in this study chalk this reality up to the fact that women physicians practice differently from men.

The Research

In a 2016 article titled “Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians,” a group of Harvard researchers examined a large random sample of Medicare fee-for-service beneficiaries between January 1, 2011 and December 31, 2014, amounting to more than 1.5 million hospitalizations.

The average age of the hospitalized patient was about 80 years old.

According to the researchers, patients treated by female hospitalists for a wide range of conditions had a lower 30-day mortality rate and lower 30-day readmission rate than did similar patients treated by male hospitalists.

For elderly patients with serious medical problems who require hospitalization, probably the two greatest objective indicators of unsuccessful clinical treatment in a hospital setting are (1) how many patients end up dying after discharge, measured in this study by the 30-day mortality rate, and (2) the number of people who end up getting readmitted to the hospital for the same reason, measured in this study by the 30-day readmission rate.

Specifically, in this study, the 30-day adjusted patient mortality measured among female physicians was 11.07 percent and that of men was 11.49 percent. The 30-day adjusted readmission rate was 15.02 percent among female providers and 15.57 percent among male providers.

Although a less than 1 percent difference in all these rates may seem small, consider that these differences could mean that—if this association was proven to be causal—an additional 32,000 lives could be saved in the Medicare population alone if male hospitalists achieved the same clinical outcomes as women do.

If this association were to translate to non-Medicare populations, the effect could be much larger.

To humanize these projections, 32,000 fewer deaths mean that there would be thousands of more American grandparents out there who could celebrate birthdays, graduations, and holiday parties. And remember that memories are priceless.

Why the Difference?

According to the researchers, “Literature has shown that female physicians may be more likely to adhere to clinical guidelines, provide preventive care more often, use more patient-centered communication, perform as well or better on standardized examinations, and provide more psychosocial counseling to their patients than do their male peers.” Furthermore, these differences in clinical practice appear to carry over to primary, or outpatient, care, too.

The current study is the first to show that such differences could somehow contribute to better patient outcomes.

The researchers have no exact idea why these results were observed. Physician sex in no way solely dictates whether an elderly patient either fares better or lives after being discharged from the hospital. Instead, physician sex is a marker of other moderating variables that contribute to patient welfare, such as clinical decision-making.

Interestingly, the researchers hypothesize that based on data from industries other than health care, men may be less deliberate when solving complex problems.

On a related note, it’s unclear whether transgender physicians experience better or worse clinical outcomes than either male or female physicians do. Sociodemographic data in this study were self-reported, and responses of physician participants were limited to either man or woman ... no transgender option was presented.

What Does All This Mean to You?

First, let me tell you what the results of this study don’t mean. These results don’t mean that next time that your elderly loved one is hospitalized, a female hospitalist is best. All physicians are different, and there are plenty of excellent male and female physicians out there. Please remember that the results of this study suggest an association between the sex of the hospitalist and how well members of a specific patient population fare after leaving the hospital—that’s it.

Another mistaken interpretation of the results of this study involves extending this association to all types of physicians. The researchers in this study looked at inpatient, or hospital, care provided by female and male general internists. Although differences in practice between male and female physicians have been observed in outpatient clinical (office) settings, it's unclear whether the association between better clinical outcomes and female sex of the health care provider are linked in any way across a gamut of specialties, and we have no evidence supporting such links. More research would be need to be done to test whether this association holds true in settings outside the hospital.

In other words, the results of this study shouldn't dictate preference in a variety of clinical settings. You shouldn't read this article or study and then always choose a female health provider, be it a primary care physician, surgeon or other specialist, because you think that she will provide better care than her male colleagues.

Instead, the results of this study call into question the more common-sense existential assumption that male and female physicians should, on average, provide comparable care. The results of this study suggest that there may be something special about the care that female hospitalists provide that translates into better service. It’s unclear whether this special difference could be taught to or otherwise replicated among their male counterparts.

From a social perspective, this study further highlights a cruel reality of the workforce; that even if a woman were to do her job better than a man, she will likely still get paid less. In reality, both male and female physicians are usually paid substantial amounts of money, and gender pay gap is likely more alarming and exigent, for example, among single mothers struggling to provide for their families. Nevertheless, in light of this recent study out of Harvard, gender pay gap differences among female hospitalists appear to be particularly glaring.

Sources:

Corbett, C and Hill C. Graduating to a Pay Gap. www.aauw.org.

Jena, AB, Olenski AR, and Blumenthal DM. “Sex Differences in Physician Salary in US Public Medical Schools.” JAMA Internal Medicine. 2016; 176: 9.

The Equal Pay Act of 1963. U.S. Equal Employment Opportunity Commission. https://www.eeoc.gov/laws/statutes/epa.cfm

Tsugawa, Y, et al. “Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians.” JAMA Internal Medicine.

Continue Reading