Does Surgeon Sex Matter?

Practice Patterns and Outcomes of Female and Male Surgeons

Catherine E. Sharoky, MD; Morgan M. Sellers, MD; Luke J. Keele, PhD; Christopher J. Wirtalla, BA; Giorgos C. Karakousis, MD; Jon B. Morris, MD; Rachel R. Kelz, MD, MSCE

Disclosures

Annals of Surgery. 2018;267(6):1069-1076. 

In This Article

Abstract and Introduction

Abstract

Objective: We sought to compare postoperative outcomes of female surgeons (FS) and male surgeons (MS) within general surgery.

Summary of Background Data: FS in the workforce are increasing in number. Female physicians provide exceptional care in other specialties. Differences in surgical outcomes of FS and MS have not been examined.

Methods: We linked the AMA Physician Masterfile to discharge claims from New York, Florida, and Pennsylvania (2012 to 2013) to examine practice patterns and to compare surgical outcomes of FS and MS. We paired FS and MS operating at the same hospital using cardinality matching with refined balance and compared inpatient mortality, any postoperative complication, and prolonged length of stay (pLOS) in FS and MS.

Results: Overall practice patterns differed between the 663 FS and 3219 MS. We identified 2462 surgeons (19% FS, 81% MS) at 429 hospitals who met inclusion criteria for outcomes analysis. FS were younger (mean age ± SD FS: 48.5 ± 8.4 years, MS: 54.3 ± 9.4y; P < 0.001) with less clinical experience (mean years ± SD FS: 11.6 ± 8.3 y, MS: 17.6 ± 10.0 years; P < 0.001) than MS before matching. FS had lower rates of inpatient mortality (FS: 1.51%, MS: 2.30%; P < 0.001), any postoperative complication (FS: 12.6%, MS: 16.1%; P < 0.001), and pLOS (FS: 18.4%, MS: 20.7%; P < 0.001) before matching. After matching, FS and MS outcomes were equivalent.

Conclusion: Surgeon practice patterns vary by sex and experience. FS and MS with similar characteristics who treat similar patients at the same hospital have equivalent rates of inpatient morality, postoperative complications, and prolonged length of hospital stay. Patients should select the surgeon who is the best fit for them regardless of sex.

Introduction

The last several decades have seen a slow but steady increase in the number of female surgeons (FS) in the field of general surgery. Women now make up approximately 12% of the general surgery workforce,[1] compared with 5% in 1997.[2] FS currently hold 22% of full-time faculty positions in academic surgical departments in the United States; however, only 10% are full professors, and even fewer hold departmental or divisional leadership positions.[3] Women now make up 50.8% of the US population and 49.8% of matriculating medical students.[4] Many have suggested that we need to increase diversity within the field of surgery.

Recent evidence suggests that women in primary care provide exceptional care. A widely publicized 2017 study showed that Medicare patients treated by female internists had lower mortality and readmission rates than those treated by male internists at the same hospitals.[5] Study authors pointed to differences in practice style, specifically that female physicians tend to adhere more closely to evidence-based guidelines and focus more on patient-centered care,[5] as a potential explanation for their findings.

To date, no one has examined the outcomes of patients treated by FS. As surgery is a male-dominated specialty, it is possible that the findings within medicine may not generalize to the field of surgery. Studies of women in surgery have focused primarily on quality of life and attrition.[6–10] In this study, we sought to examine FS and male surgeon (MS) practice patterns. We then examined differences in outcomes of patients by surgeon sex.

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