The headlines blared just before December's holiday season hit full swing — from NBC News: “Female Doctors Outperform Male Counterparts: Study”; Washington Post: “Women really are better doctors, study suggests”; USA Today: “Don't want to die before your time? Get a female doctor”; and The Atlantic: “Evidence of the Superiority of Female Doctors: New research estimates that if all physicians were female, 32,000 fewer Americans would die every year.”
The focus of this widespread coverage was the study “Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians” published Dec. 19 in JAMA Internal Medicine conducted by a team of Harvard researchers who sought to answer this question: Do patient outcomes differ between those treated by male and female physicians?
They studied 30-day mortality rates for 1.58 million hospitalizations for Medicare enrollees (621,412 male and 961,616 female) and 30-day readmission rates for 1.54 million Medicare enrollees (602,115 male and 938,682 female) across eight common medical conditions treated by male and female general internists from 2011 to 2014. After controlling for patient severity and hospital characteristics, they isolated their analysis around the relevance of the clinician’s sex as a determinant of outcomes for the following condiditons: sepsis, pneumonia, congestive heart failure, chronic obstructive pulmonary disease, urinary tract infection, acute renal failure, arrhythmia and gastrointestinal bleeding.
The implications for health and health care best practices are potentially extensive. Very little work has been done that examines the association between physician gender and patient mortality. Moreover, the findings challenge the belief that “childrearing, higher rates of part-time employment, and greater tradeoffs between home and work responsibilities” potentially compromise the quality of care provided by female physicians and justify higher salaries among male physicians.”
The article notes that patients treated by female physicians had significantly lower adjusted mortality rates, at 11.07 percent vs. 11.49 percent for males. Adjusted readmission rates were also lower, registering 15.02 percent vs. 15.57 percent for men doctors, with both sets of comparisons looking at physicians in the same hospital.
In extrapolating their finding to the full population of 10 million or so Medicare discharges, the authors calculated that "approximately 32,000 fewer patients would die if male physicians could achieve the same outcomes as female physicians every year.”
In their discussion, they offered that “There is evidence that men and women may practice medicine differently. 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.”
For hospitals and health system leaders, boards and medical staff, this study deserves discussion.
But first, it’s necessary to understand the limitation of the study itself. The methodology is credible and the findings verifiable with two important caveats: the clinicians upon which the study comparison is premised were general internists with significant inpatient responsibilities. Had the study been done on outcome comparisons for orthopedists, emergency room clinicians and others, or the clinical populations increased to include conditions like cancer, heart failure and others prevalent among Medicare enrollees, the results might not be replicable. And, as a result, the projection that 32,000 deaths among Medicare enrollees that might be avoided if care was provided by female clinicians might be somewhat misleading.
The question of whether patient outcomes are directly affected by physicians' personality, communications style and behavior is a serious matter. Surely, in this era of social media, getting out ahead of risks associated with physician deficiencies, even among physicians with exceptional clinical acumen, is necessary if not imperative.
The study attracted widespread attention because it’s key finding is sensational. There’s no escaping media scrutiny and public interest in the performance of physicians, whether faltering or not.
So, the following suggestions might be a start for hospital leaders:
- Educate medical staff leaders, trustees and management about best practices in defining and measuring optimal physician performance.
- Review the hospital’s credentialing, and medical staff disciplinary procedures and quality measures to integrate the full range of physician performance factors.
- Establish an intervention program to assist problematic physicians in improving their performance in defined areas of deficiency.
- Be objective about the issue, not dismissive. It’s a serious concern.
The profession of medicine is respected and trusted, but it’s also fallible and prone to self-interest. One in three of our physicians are female, which brings notable advantages as identified in this important study. It is in the best interest of our patients, our communities and the profession to consider this topic seriously and act appropriately.
Paul H. Keckley, Ph.D. (firstname.lastname@example.org), does independent health research and policy analysis and is managing editor of The Keckley Report. He is a member of Speakers Express; for speaking opportunities, please contact Laura Woodburn. Marina Karp can be reached at email@example.com.
The opinions expressed by the authors do not necessarily reflect the policy of the American Hospital Association.