Fewer Deaths Among Patients Of Female Doctors: Are Male Doctors Doing Something Wrong?
Researchers at McMaster University and several other Ontario, Canada, institutions have documented a shocking difference in outcomes for patients of female doctors and male doctors. Looking back at deaths in the general medical wards of seven hospitals in the Toronto area during the more than seven-year period between April 1, 2010, and October 31, 2017, the team found more deaths among patients of male doctors. These results, published in “Variations in Processes of Care and Outcomes for Hospitalized General Medicine Patients Treated by Female vs Male Physicians” in JAMA Health Forum, jive with ones derived in 2017 by a United States-based team from Harvard, Massachusetts General Hospital, and several other Boston area institutions. However, according to the Canadian study’s lead author Anjali Sergeant of McMaster University, the difference between male and female patient mortality rates may be only partially explained by gender.
Sergeant and the team examined outcomes for almost 172,00 patients, of which about half were men and half were women. The patients’ median age was 73 years. All patients had been admitted through the emergency department.
During the years surveyed, 54 female physicians and 118 male physicians cared for the patients. All of the doctors were general internists or family physician-hospitalists.
Patients of female doctors died at a rate of 4.8%. This was as opposed to the 5.2% death rate for patients of male doctors.
What Drove the Mortality Rates?
Before collating and analyzing the numbers for the Canadian study, the researchers knew from a 2013 study published in the Canadian Medical Association Journal that female doctors surveyed were more likely to provide “preventive care” including regular checkups, immunizations, and standard screenings. Male doctors, on the other hand, were more likely to provide “diagnostic care” — trying to figure out what’s wrong with someone who’s already sick. Other prior studies had shown female doctors to be more likely to follow guidelines for how to diagnose and treat any given condition. They were found to be more likely to spend more time communicating with patients to educate them and to integrate into the clinical plan the patient’s preferences and desired outcomes. Female doctors were more likely to have performed well on qualifying exams. Female physicians also spend more time on direct patient care, which means they see fewer patients and generate less revenue for the practice. They also typically get paid less.
In the new Canadian study, the researchers found that, in general, the male physicians at the seven hospitals were older than the females and had more experience practicing medicine. “Years practicing medicine” seemed to be a compelling determinant of the difference in patient mortality. It predicted more deaths. This suggested to the researchers that completing medical residency only a few years prior and therefore being relatively awash in current diagnostic and treatment methods may work to physicians’ — and therefore patients’ — advantage. Relative newcomers to the practice of medicine may also read patient electronic medical records more carefully, consult with colleagues more often, order more tests, prescribe more cautiously, and refer patients to specialists more readily. (Not incidentally, perhaps, the female physicians in the study ordered significantly more imaging tests, including CT scans, MRIs, and ultrasounds.)
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“Part of the difference in patient mortality was related to the number of years that doctors practiced medicine,” Sergeant explained by email. “Other potential factors explaining why female doctors had better patient outcomes in this study remain unknown. We did not directly examine whether physicians who were more recent grads had better patient outcomes, but further research in this field would enable us to determine how big of an impact this factor plays in patient mortality.”
Can having a male doctor kill you? Once the researchers adjusted their data for physician characteristics including age and years of experience, they concluded that, while mortality rates differed according to physician gender, they probably did not differ entirely because of gender. Even so, as Sergeant pointed out, “There was still a gender association present.”
Future research may explore how male and female physicians of any age and experience give care. Subtle male or female characteristics may one day be shown to play a role in whether a patient lives or dies. Perhaps not, however. Factors that get tied to gender but that instead reflect the sociological shift taking place in medicine merit close examination. Right now, all that’s known for sure is that one large Canadian study and at least one large United States study have demonstrated a significant difference in patient outcome based on the gender of the physician. Meanwhile, it does look like male and female physicians in general practice medicine a little differently.
The authors of “Variations in Processes of Care and Outcomes for Hospitalized General Medicine Patients Treated by Female vs Male Physicians” are Anjali Sergeant, BASc; Sudipta Saha, SM; Saeha Shin, MPH; AdinaWeinerman, MD; Janice L. Kwan, MD, MPH; Lauren Lapointe-Shaw, MD, PhD; Terence Tang, MD; Gillian Hawker,MD, MSc; Paula A. Rochon, MD, MPH; Amol A. Verma, MD, MPhil; Fahad Razak, MD, MSc