COMMENTARY

Battle of the Sexes: Who Gives Better Medical Care?

Arghavan Salles, MD, PhD

Disclosures

March 01, 2021

Should patients care about gender when choosing a doctor? Will they be better off with a man, a woman, or another gender?

People have been trying to answer this question one way or another since at least the 1990s. Unfortunately, pretty much all the published data consider gender as a binary variable, so for now, our evidence-based conversation is limited to men and women.

One of the earliest major papers investigating how the care provided by women may differ from that of men was published in The New England Journal of Medicine in 1993. The investigators looked at visits for almost 100,000 women patients with over 1200 physicians and assessed how often Pap smears and screening mammograms were done. They found that women physicians were more likely than men physicians to order both.

Over the past three decades, researchers have described quite a number of ways in which the care women provide may be more patient-centered, participatory, and positive. For example, women are more likely than men to assess the opinions and needs of their patients; build partnerships; follow guidelines and refer patients to a specialist; and counsel patients regarding alcohol, tobacco, and unsafe sexual behaviors. Women also spend more time with patients, and patients of women physicians are less likely to go to the emergency department (ED) or get admitted to the hospital.

Three major studies in recent years looked beyond how doctors' care is perceived or how they spend their time and examined patient outcomes instead.

In 2016, Tsugawa and colleagues reviewed the outcomes of patients cared for by internists. They examined Medicare data for eight common conditions (eg, sepsis, pneumonia, congestive heart failure) encompassing 1.6 million hospitalizations and more than 58,000 physicians. They consistently found that patients cared for by women physicians were less likely to die or be readmitted within 30 days of discharge. They concluded that "approximately 32,000 fewer patients would die if male physicians could achieve the same outcomes as female physicians every year."

One year later, another team of researchers assessed the outcomes of patients who had undergone one of 25 surgical procedures (eg, coronary artery bypass graft, appendectomy, cholecystectomy, total knee replacement) by the gender of the surgeon. Among more than 100,000 patients, those who were cared for by women had lower risk for death.

Finally, in a landmark 2018 study, Greenwood and colleagues found that patients who came to the emergency department with heart attacks were more likely to survive if they were cared for by a woman rather than a man. Among patient-physician gender pairings, women patients cared for by men physicians had the worst outcomes; women patients cared for by women physicians had the best outcomes. Of note, the number of women physicians in the emergency department was positively correlated with better outcomes for women patients.

What Does This Mean?

This doesn't necessarily mean that all women are better physicians than all men. The data do show, however, that women bring particular strengths to the job of caring, especially when it comes to treating the patient as a whole rather than focusing on a specific diagnosis; there seem to be some advantages to this approach.

Greenwood and colleagues observed that men physicians became better at caring for women patients as they gained more experience caring for women, meaning that the women seen earlier in their careers may receive worse care. The authors concluded, "Given the cost of male physicians' learning on the job, it may be more effective to increase the presence of female physicians within the ED."

So should patients pick a woman or a man to be their doctor? That's up to them. This (woman) doctor recommends, as always, following the evidence.

What About Race?

One major gap in all of these data is any accounting for race or ethnicity. We know, for example, that Black women are more likely than White women to die in childbirth. And Black men opted into more preventive care when their physician was also Black (compared with when the physician was not Black).

The COVID pandemic has strongly underlined the preexisting racial disparities in healthcare. Black, Hispanic, and Indigenous people are more likely than others to contract and die of COVID. For too long, intersecting identities, such as gender and race, have been ignored. These disparities, for COVID and beyond, must be addressed in any future research on patient care outcomes.

Arghavan Salles, MD, PhD, is a bariatric surgeon and gender equity researcher. She is a founder of TIME'S UP Healthcare and an advisor to the Women in Medicine Symposium.

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