Patients treated by female doctors less likely to die, study shows

Some previous studies have suggested that female physicians may provide higher quality medical care, but patient outcomes have never been investigated. New research aims to fill this research gap by examining whether patient outcomes are different for those treated by male and female doctors, respectively.

New research suggests that patients treated by female physicians have better clinical outcomes.

A team of researchers, from Harvard T.H. Chan School of Public Health in Boston, MA, set out to see if potential gender differences in clinical practice had an impact on patient clinical outcomes.
The authors were motivated by previous research, which suggested that male and female physicians differed in their medical practice. For instance, female physicians tend to adhere to clinical guidelines more strictly, provide more preventive care, and use more patient-centered communication than their male counterparts.
Despite this, female physicians are paid significantly less than their male counterparts, with various authors offering different explanations for this pay gap.
In this context, a team of researchers - led by Yusuke Tsugawa, research associate in the Department of Health Policy and Management - decided that an examination of patient outcomes was necessary.
The results were published in the journal JAMA Internal Medicine.

Evaluating the links between patient outcomes and physician gender

Researchers analyzed a 20 percent sample of Medicare Inpatient and Carrier Files, and they identified 1 million beneficiaries aged 65 or older who were admitted to acute care hospitals between January 1, 2011, and December 31, 2014.
The scientists examined associations between the physicians' sex and the patients' 30-day mortality rate (that is, how many patients died within 30 days of admission), as well as their 30-day readmission rate (whether patients were readmitted within 30 days of being discharged.)
To ensure the reliability of the results, Tsugawa and team used three regression models. The first model adjusted for patient characteristics, the second one additionally adjusted for hospital effects, and the third model considered all the variables in models one and two plus physician characteristics.
Researchers also evaluated whether the differences in patient outcomes varied according to the primary condition that a patient was admitted for, as well as the severity of the illness.
Finally, scientists looked at potential mechanisms that could explain the differences they observed. Some of these possibilities included different lengths of stay, use of care, and patient volume.
To account for the possibility that male physicians might be more likely to treat severely ill patients in intensive care units, researchers excluded hospitals with a medical intensive care unit.

Patients treated by women have lower mortality and readmission rates

Tsugawa and team discovered a range of differences between male and female physicians. For instance, female physicians were younger and treated fewer patients than their male counterparts.
More importantly, however, patients cared for by female doctors had a significantly lower 30-day mortality rate than patients treated by male physicians.
Overall, patients treated by female physicians had a 4 percent lower relative risk of dying, and a 5 percent lower risk of being rehospitalized.
The 30-day mortality rate for all the patients was 179,162, or 11.32 percent.
Patients treated by female doctors had a 10.82 percent mortality rate, compared with 11.49 percent of patients treated by male physicians. These differences were little or not at all affected by various adjustments.
The authors point out that while these numbers may seem modest, they translate into a clinically meaningful relative difference.
Patients cared for by female physicians also had significantly lower readmission rates than those with male doctors.
The overall 30-day readmission rate was 237,644, or 15.42 percent. After adjustments for patient characteristics, hospital effects, and physician characteristics, female physicians still had a 15.57 percent readmission rate, compared with 15.01 percent for those with male doctors.

Women may provide better care, but gender discrimination persists

The findings were consistent across a variety of conditions and differences in severity of illness, and they were deemed "surprising" by the researchers.

"The difference in mortality rates surprised us. The gender of the physician appears to be particularly significant for the sickest patients. These findings indicate that potential differences in practice patterns between male and female physicians may have important clinical implications."

Yusuke Tsugawa

According to existing research quoted by the authors, some of the differences in clinical practice include the tendency of female physicians to practice evidence-based medicine, perform just as well or better on standardized tests, and provide more patient-centered care. 

Considering evidence from other work industries, the authors hypothesize that men's tendency to take unnecessary risks and be overconfident in their problem-solving abilities may also play a role.
Ashish Jha, director of the Harvard Global Health Institute and senior author of the study, emphasizes that while the causes for their findings remain unknown, they are important for the patients' well-being.
"There was ample evidence that male and female physicians practice medicine differently," Jha says. "Our findings suggest that those differences matter and are important to patient health. We need to understand why female physicians have lower mortality so that all patients can have the best possible outcomes, irrespective of the gender of their physician."
Jha also notes that women doctors tend to be treated differently because of their gender. For instance, they are less likely to be promoted and have lower salaries. 

Elderly patients are less likely to die or be readmitted to the hospital when they’re treated by a female physician than by a male physician, according to new research.

It’s yet another reason why it’s ridiculous for male doctors to out-earn female docs by an average of $20,000 each year. And it helps counter the narrative that women provide lower-quality care because they bear the burden of domestic responsibilities.

“Approximately 32,000 fewer patients would die” if male physicians could achieve the same results as female docs

Public health researchers at Harvard University waded through three years of records for patients in the US ages 65 and up. They took a random sample of 20 percent of people receiving Medicare who had been hospitalized between January 2011, and December 2014. The researchers discovered that no matter what medical condition landed the patient in the hospital, that patient was more likely to die or be readmitted to the hospital in the following 30 days if they were treated by a male physician — according to results published Monday in JAMA Internal Medicine.

For some conditions, like sepsis, pneumonia, acute kidney failure, and irregular heartbeats, the decrease in deaths after treatment by a female physician was statistically significant. For other conditions, like congestive heart failure, urinary tract infections, and gastrointestinal bleeding, the drop in deaths was more of a trend. But for almost all conditions, readmissions decreased significantly for patients treated by a female physician compared to ones treated by a male physician.

While this specific study didn’t look at why patients treated by women did so much better, the authors reference previous studies. These showed that women generally score better on medical standardized tests, they’re more likely to use best-practices when treating patients, and to spend time communicating with their patients.

With an association study like this one, it’s important for the researchers to be comparing apples and apples, not apples and oranges. So, the research team made sure to compare doctors within the same hospitals, and to focus specifically on doctors providing hospital care.

Still, as careful as they were, the researchers couldn’t say for certain that something about medical care by female physicians caused that decrease in deaths — just that the outcome was linked to the physician’s gender. But if they could assume a direct relationship, the authors say, and extrapolate that data to the 10 million Medicare hospitalizations a year in the US, there would be a lot fewer deaths: “We estimate that approximately 32,000 fewer patients would die if male physicians could achieve the same outcomes as female physicians every year.”

More Patient-Centered Interviewing

In analyzing the various studies, however, Roter and Hall found female physicians were much more likely to engage in "patient-centered" interviewing by actively enlisting patient input, counseling, and exploring larger life-context issues that affect patients' conditions.
"Female physicians are more likely to talk about lifestyle issues and psychosocial issues," says Roter. "They're more likely to engage in conversations of feelings and emotions and those conversations take time."
A study published in 2009 in the Australian and New Zealand Journal of Psychiatry echoed those findings. Researchers at a depression clinic found female general practitioners wrote longer referral letters detailing their patients' symptoms. In a subsequent survey of 500 patients suffering from depression, patients of female general practitioners said their doctors were more caring, took more time, and were better listeners than patients of male physicians.
Research shows patients respond to female physicians' more patient-centered approach by disclosing more about both their medical symptoms and their lifestyles, Roter says. She notes that female doctors in primary care do more counseling in preventive or self care, such as mammography, pap smears, and screening for seatbelts and alcohol consumption and are more successful at getting patients to have preventive care screenings.
One of the areas where male and female doctors do not differ is "social chit chat," Roter says. "The conversations female doctors are having during these visits are medically relevant."

Patients, Practice Settings Are Important

While the extended-play conversations female docs have with their patients may be medically important, male doctors take issue with the idea that women are innately better communicators or that their patients may be more willing to disclose important details about their health.
"Certainly no one can argue that there are some generalizations that can be made about communication styles," says Greg Hood, MD, a general internist in Lexington, Kentucky, and Governor of the Kentucky chapter of the American College of Physicians. "But you can't take from that that women are universally more empathetic or more caring.
"Physician styles are something that patients self select for; they'll go from one group to another to find the physician with whom they connect the most. In my experience predicting what a patient's preference will be in terms of physician approach or physician style is really a fool's errand because we are not movie characters. We're real people and we're very complex. When 2 people -- a physician and a patient – are relating to each other about complex health issues, you can't make a straightforward assertion about how they'll relate based on gender. I think it is very circumspect."
Indeed, research shows a patient's gender has a lot to with how they interact with their doctors and the length of the interaction. Female patients -- the primary consumers of healthcare -- who have female doctors have the longest interactions followed by male patients with female doctors, female patients with male doctors, and, lastly, male patients with male doctors.
As for the few extra minutes female physicians generally spend with their patients, Dr. Hood muses whether the differential might be attributable to a sense of competition among male physicians to see more patients or to a feeling of responsibility that the primary breadwinner in the household -- be it a man or a woman -- might have to maximize earnings

Physician Burnout – Gender Differences in Burnout Symptoms.

Numerous studies have shown that an average of 1 in 3 practicing physicians are suffering from symptomatic physician burnout on any given office day … worldwide, regardless of specialty.
The three classic signs and symptoms of physician burnout are measured by a standardized evaluation; the Maslach Burnout Inventory (MBI). They are:

1) Emotional Exhaustion

The doctor is tapped out after the office day, hospital rounds or being on call and is unable to recover with time off. Over time their energy level begins to follow a downward spiral.

2) “Depersonalization”

This shows up as cynicism or a negative, callous, excessively detached response to their job duties. Often burned out doctors will begin to blame and complain about their patients and their problems.

3) “Reduced Accomplishment”

Here physician burnout has the doctor start to question whether they are offering quality care and whether what they do really matters at all.

As more female doctors move into the workforce, researchers are beginning to notice differences in the way physician burnout presents in men and women.

If you think for a moment about the three scales of the MBI, you will probably be able to imagine the differences. Here is what groundbreaking physician burnout research published in 2011 is showing.

NOTE:
This study is based on practicing physicians. There is good reason to believe the following Burnout symptom patterns
are true in ANY stressful profession such as Therapists, Law Enforcement, Military personnel and even Parenting.

The Female Pattern:

Women suffering from physician burnout seem to follow the classic three part pattern of the MBI above – in that order.

Stage One:

Burnout in female doctors starts with Emotional Exhaustion. Women traditionally support others in numerous areas of their lives … at home and at work. There is only so much energy and giving to go around.

Stage Two:

Depersonalization and cynicism. This is a dysfunctional coping mechanism. It feels somewhat better for an instant in time and yet does nothing to relieve the feeling of chronic exhaustion caused by physician burnout. Cynicism is especially difficult for women to keep up for very long before stage three kicks in.

Stage Three:

Reduced Accomplishment and doubting the quality of their practice and the difference their work makes in their patients lives.

The Male Pattern:

Stage One:

Men more commonly start physician burnout with depersonalization and cynicism which serves as a coping mechanism for overwhelming stress. “My patients are such a bunch of $%@+!%”. This is, again, a dysfunctional response to the inherent stress of being a doctor and is only a temporary relief. After all, these are the people you spent decades learning to serve.

Stage Two:

Emotional exhaustion follows. It worsens until they are no longer able to cope.

Stage Three:

By comparison to the female physician Burnout pattern, men’s stage three is remarkable for it’s absence. Male physicians are far less likely to feel that the symptoms of stages one and two affect the quality of the care they offer. This leads to a cynical, exhausted male physician who keeps going despite Burnout because they feel they are still a “good doctor”. This lack of a phase three allows them to continue to practice in denial of their distress despite the exhaustion and cynicism their coworkers and patients witness on the job.

Early Warning Signs by Gender

If you are a practicing physician – or a worker in any job you where you are feeling stressed – here are the early warning signs of physician Burnout to watch for.

Women:

Exhaustion and a feeling of not being able to recharge your batteries, followed by early signs of blaming your patients or clients.

Men:

Cynicism and blaming your patients or clients, followed by exhaustion and falling energy and engagement.

When you notice these signs, take a breath and a break.
Recognize them for what they are – Physician Burnout.

This is a cue

• Step back
• Take a breath
• Start taking better care of your own personal needs
• Create some boundaries for a more balanced life

You, your staff, your patients and your family will be glad you did.