Male physicians worldwide are nearly two and half times more likely to have medical-related legal action taken against them than their female counterparts, according to research published online August 13 in BMC Medicine.
Emily Unwin, a PhD candidate in the medical school at University College London in the United Kingdom, and colleagues did a meta-analysis of 32 studies and found a pooled odds ratio of 2.45 (95% confidence interval [CI], 2.05 - 2.93) that men were more likely the targets of action. In none of the studies were women physicians more likely to be the targets of legal action.
"The size of the effect of sex on experience of medico-legal action remained roughly constant in all subgroup analyses, suggesting that the effect of sex is not influenced by the study design, the country the doctor is in employed in, or the outcome definition, and the effect seems stable over time," the authors write.
Theories on Causes
The authors did not analyze reasons for the disparity. However, they said past explanations have included that men outnumber women in the field. But if that were the reason for the disparity, then the numbers should be evening out, because the numbers of women physicians have been going up globally. Instead, the size of the legal actions gap has been steady for the last 15 years.
Some have reasoned that male physicians work more hours, and therefore come in contact with more patients. Those possible links need further study, the authors say.
The study comes at a time when legal actions against physicians are rising in general. In the United States, between 2008 and 2012, there was a 17% increase in the number of medical licenses revoked, denied, or suspended. In the United Kingdom, the medical regulator, the General Medical Council, saw a 64% increase in complaints between 2010 and 2013.
Identifying predictors of disciplinary action could help reduce the burden of investigations.
Some previous studies have looked at the medicolegal action taken relative to sex in specific countries, but this study looked at the issue globally.
The results of studies found in MEDLINE, EMBASE, and PsycINFO represented a population of 4,054,551 and included 40,246 cases of medico-legal action. The researchers included studies with original data, written in English or French, examining the association between sex and medicolegal action against physicians.
Complaints included six categories: disciplinary action by a medical regulatory board, malpractice claims/cases, referral to a regulatory board, complaint to a healthcare complaints body, criminal cases, and medicolegal matters with a medical defense organization (a grouping together of several medicolegal action types).
Further research is needed to understand the sex imbalance in legal claims, the authors say. "The causes are likely to be complex and multi-factorial, but the first step is to recognize that there is a difference, and this study shows that robustly. Medical schools, medical regulatory authorities, and researchers now need to work together to try to further understand the difference between the sexes that could explain the difference in experience of medicolegal action, with the aim of better supporting our doctors and improving patient safety."
One coauthor reports receiving grants from the General Medical Council.
BMC Med. Published online August 13, 2015. Full text
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