Female vs Male Physicians: Better Outcomes?

Diana Phillips

December 19, 2016

Elderly hospitalized patients who receive care from a female physician have lower mortality and readmission rates than those who are cared for by male physicians within the same hospital, a study has shown.

The findings appear to validate to the results of earlier studies suggesting that patient-centered communications and other practice behaviors frequently associated with female providers may have important clinical implications, the researchers write.

Uysuke Tsugawa, MD, MPH, from Harvard T. H. Chan School of Public Health, Boston, Massachusetts, and colleagues published their study online December 19 in JAMA Internal Medicine.

The results also appear to refute the argument that quality of care provided by female physicians seeking to balance work and family responsibilities may be compromised, which has been used to explain differences in the pay and professional advancement of female physicians relative to their male colleagues.

The researchers analyzed a national sample of Medicare beneficiaries who were hospitalized for medical conditions in acute care facilities from January 1, 2011, through December 31, 2014. They looked specifically at 30-day mortality and readmission rates across more than 1.5 million patient hospitalizations for each outcome to determine whether or not and to what degree physician sex influences clinical outcomes of hospitalized patients.

Of 58,344 general internists who treated at least one Medicare beneficiary hospitalized with a medical condition, 18,751 (32.1%) were women. Compared with the male physicians included in the analysis, female physicians were younger (mean, 42.8 vs 47.8 years), were also more likely to have undergone osteopathic training (8.4% vs 7.0%), and treated fewer patients annually (131.9 vs 180.5 hospitalized patients).

The characteristics of patients who were treated by female physicians were similar to those treated by male physicians with respect to mean age (80.8 and 80.6 years, respectively), race, household income, Medicaid coverage, and coexisting conditions. The only slight between-group difference was a slightly higher proportion of female patients receiving care from a female physician (62.1% vs 60.2%).

For the analysis of 30-day mortality rates, overall mortality of the full sample (1,583,028 hospitalizations treated by 57,896 physicians) was 179,162. After adjusting for fixed hospital and physician characteristics, the rate for patients cared for by a female physician was 11.07% compared with 11.49% for those treated by male physicians (adjusted risk difference, −0.43%; 95% confidence interval, −0.57% to −0.28%; P < .001; number needed to treat, 233).

For the 30-day readmission analysis, which included 1,540,797 hospitalizations treated by 57,876 physicians, the overall readmission rate was 15.42% (237,644 readmissions). The adjusted readmission rate for patients of female physicians was 15.02% compared with 15.57% for patients of male physicians (adjusted risk difference, −0.55%; 95% confidence interval, −0.71% to −0.39%; P < .001; number needed to treat, 182), the authors report.

"Patients of female physicians had lower mortality and readmission rates across all medical conditions we examined," the authors write, noting that the magnitude and statistical significance of the differences varied by condition.

Specifically, statistically significant differences were observed in mortality rates for female physicians' patients being treated for sepsis, pneumonia, acute renal failure, and arrhythmia. The mortality differences by physician sex were not statistically significant for patients with congestive heart failure, urinary tract infection, and gastrointestinal bleeding, the authors report.

"Patients' readmission rates were significantly lower for female physicians than male physicians for most of the conditions," they write.

Similar patterns were observed when the researchers restricted the sample to patients treated by hospitalists.

Taken together, these findings "are consistent with results from prior studies of process measures of quality," the authors write. "There is evidence in the primary care setting suggesting that, compared with male physicians, female physicians are more likely to practice evidence-based medicine, perform as well or better on standardized examinations, and provide more patient-centered care."

Sex-based differences in problem-solving approaches may also play a role in the care variations, the authors suggest.

The authors point out that, although modest, the difference in patient mortality by sex, a relative risk reduction of 4% in mortality, "is arguably a clinically meaningful difference," noting that the effect size is of comparable magnitude in the decline in all-cause mortality in Medicare beneficiaries between 2003 and 2013, which has been attributed to improvements in care quality and treatments.

"[G]iven that there are more than 10 million Medicare hospitalizations due to medical conditions in the United States annually and assuming that the association between sex and mortality is causal, we estimate that approximately 32,000 fewer patients would die if male physicians could achieve the same outcomes as female physicians every year," the authors stress.

As previous studies have suggested, the findings of the current investigation suggest that sex-related differences in practice patterns between male and female physicians "may have important clinical implications for patient outcomes," the authors write. "Understanding exactly why these differences in care quality and practice patterns exist may provide valuable insights into improving quality of care for all patients, irrespective of who provides their care."

The findings of the study, as well as any additional insight into the drivers of physician sex-related outcome disparities, may ultimately be important factors in narrowing the financial and professional-development gap between female and male physicians, as recently reported by Medscape Medical News, according to the authors of an accompanying editorial.

"Previous work has shown that female physicians have a more patient-centered communication style, are more encouraging and reassuring, and have longer visits than male physicians," write Anna L. Parks, MD, and Rita F. Redberg, MD, from the University of California, San Francisco. "In a system that is increasingly focused on pay for performance, behaviors that lead to improved outcomes are rewarded, which might narrow the pay gap between the genders."

In addition, the indication that female internists provide higher-quality care for hospitalized patients should prompt changes to the policies and practices through which female physicians "are promoted, supported, and paid less than male peers in the academic setting," the editorialists write. The findings "should push us to create systems that promote equity in start-up packages, career advancement, and remuneration for all physicians. Such equity promises to result in better professional fulfilment for all physicians as well as improved patient satisfaction and outcomes."

Dr Tsugawa reports receiving support from St Luke's International University. One coauthor reports receiving consulting fees from Pfizer Inc, Hill Rom Services Inc, Bristol Myers Squibb, Novartis Pharmaceuticals, Vertex Pharmaceuticals, and Precision Health Economics. The editorialists have disclosed no relevant financial relationships.

JAMA Intern Med. Published online December 19, 2016.

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