Improve health care? More female doctors

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A poorly kept secret in medicine is that female doctors on average provide better patient care than their male counterparts. This is summarized for the general public here: Do women make better physicians? | MDLinx

And has been quantified for medicare patients here:

“…patients treated by female physicians had significantly lower mortality rates (adjusted mortality rate, 11.07% vs 11.49%) and readmission rates (adjusted readmission rate, 15.02% vs 15.57%) compared with those cared for by male physicians within the same hospital.”
Outcomes of Hospitalized Medicare Beneficiaries Treated by Male vs Female Physicians

A recent study found that this gender difference also holds true for surgeons:

“The findings of this study suggest that patients treated by female surgeons have a lower risk-adjusted likelihood of adverse postoperative outcomes at 90 days and 1 year following surgery.”
Surgeon Sex and Patients’ Long-Term Postoperative Outcomes

One caveat to this comes from a Canadian study that also reported better patient outcomes with female doctors. However, they also found that women doctors were on average younger than male doctors, and when this difference in experience was taken into account the gender difference disappeared. So it may be that what really matters is how many years have passed since med school graduation. In other words, recent up-to-date training appears to be more important than experience.

In any case, it appears that if you want to optimize your life span, get a younger female doctor.

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I always prefer to go to a female doctor or dentist around my age. I worked in a male dominated industry and the good old boys club was a real thing. My thinking was that all things being equal, any female who came up in a male dominated industry (which medicine was back then) had to be a superior performer compared to her male colleagues.

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I had a female GP, for a bit, in the late 90s. Worst crook of the lot. She was always demanding that I come back in a few months for more billable tests.

It can get ugly when you tell a Doc you aren’t going to play her game anymore.

Careful of generalizations.

Steve

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Hence the “all things being equal” condition.

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It’s not about generalizations. It is about probabilities.

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My primary, who saved my life, retired many years ago. He sold his practice to 2 female doctors. I was very hesitant to use a female doctor, but I respected my primary so much, I decided to try the new doctors. Turned out to be one of the best moves I made in my life.

She’s smart, extremely knowledgeable, never rushed, and thorough. I’m comfortable talking about any issue with her.

An example of one, but I’m sold.

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One caveat from the JAMA link: However, whether patient outcomes differ between male and female physicians is largely unknown.

I read the JAMA study, I read the abstract from the Postoperative Outcomes study.
One of the questions that I would put forward regarding outcomes, and readmission rates has to do with patient acuity, and patient overall comorbidities and preexisting risk factors between the samples.
I would venture female doctors may be more risk adverse than their male counterparts. Many studies have shown that women in general are more risk adverse than men.
A study in the British Journal of Psychology, “Gender differences in optimism, loss aversion, and attitudes toward risk” finds that men are more optimistic than women. This optimism often translates into a greater propensity to undertake risks. I would suggest that possibly male doctors are willing to pursue (overall) more high risk cases, and procedures than their female counterparts. The JAMA study looks at overall rates of readmission without further criteria.

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What if sexism causes patients with more severe illness to choose a male doctor because they think “males are better at doctoring”?

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What if sexism causes male patients to seek out male doctors and female patients seek out female doctors? Women outlive men in the US.

My aunt had a female doctor. She did not test for excess iron in my aunt’s blood, until it was too late. My aunt died of the complications of a treatable condition, because her female doc missed it.

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Interesting, as last year, my Primary Care Dr, Internal, my Dentist, my Cardiologist, all retired, only my Dermatologist, an ex-Navy Dr remains, and she’s been great… Replacements, all ladies, Dentist was a bit pushy at first, wanting to do $5K work, but I managed to settle her into a couple small fillings, apparently the prior Dentist & cleaner were letting them slide as we do 3 cleanings a year… Have yet to meet the Cardiologist, fort try was a guy, he bailed, didn’t set up the next appointment, so that had to be reset… Only one Internal med visit, she ordered additional blood tests, but all are OK…

So overall, it seems I’ve assembled a feminine flock of Docs, so far so good… What did bug me was the Primary just left, promoted into an upper level, and left no recs as far as replacements, Cardio’s rec also retired… Hectic times, for sure… A bout of Covid was covered via a phone call, a nice lady, handled it well… So one more!

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This phrase (from the Abstract) describes the problem being addressed in the study. It is not a conclusion of the study. Note that directly after this phrase is the Objective, which is “To determine whether mortality and readmission rates differ between patients treated by male or female physicians.” Mortality and readmission rates are standard measures of patient outcomes.

The study compared patient outcome relative to the severity of illness. It divided patients into quintiles, with the first quintile the least ill and the 5th quintile the most severely ill. Female doctors consistently outperformed male doctors, particularly with the 5th quintile patients. The difference is small, but consistently significant.

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The best explanation for this difference in patient outcomes is noted in the introduction of the JAMA paper:

There is evidence that men and women may practice medicine differently. Literature has shown that female physicians may be more likely to adhere to clinical guidelines,1-3 provide preventive care more often,4-11 use more patient-centered communication,12-15 perform as well or better on standardized examinations,16 and provide more psychosocial counseling to their patients than do their male peers.14

The above paragraph alone identifies 14 other studies that show significant differences in how female and male doctors practice medicine that could impact medicare patient outcomes.

In Table 1 of the JAMA study it is noted that 18,751 female physicians and 39,593 male physicians were examined. That’s a pretty big study. Female patients made up 62.1% of those treated by female doctors and 60.2% of those treated by male doctors. Not much of a difference.

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I have had good doctors and bad doctors. Some doctors were nice and not so good. Some were women some were males. That rarely made any difference.

The principles of medicine concerning how well the doctor can diagnose something is more valuable as a factor than anything else. The principle of using as few medications as possible made the difference.

The reason there may be a difference between any groups of doctors would be age. Experienced doctors are more often males. Newer doctors are more often females. That difference is coming to an end.

Note the new female doctors are inheriting patients once seen primarily by males.

We know throughout the West and in much of the South there are fewer doctors per 10k patients. Who gets care and when matters. Fewer doctors mean less preventive care. This drives the statistics crazy and unusable. Who does not get preventive care is not factored into studies generally.

When it comes to mortality and preventive care this map is very important statistically towards what is not factored into the studies.

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If we assume more female doctors in the North East and New England then there is more preventive care.

If we assume more female doctors in the West and South then we have people dying without seeing a doctor. Again measuring mortality in these studies does not measure who died unattended to by a doctor. If you have 100 deaths in NYC and a doctor saw to each of them as patients then you have one answer. If in KS you have 100 deaths but only 50 were under the care of a doctor then you have a different mortality rate. The patient load had a lower mortality rate. It is an apples-to-oranges comparison KS to NYC.

This is a large country. Females could be in larger concentrations in the Northeast Corridor and in the West and South. Other areas could have more male doctors.

Bottom line?

Trying to generalize is the worst way to make sense of this. It is an individual doctor seeing an individual patient.

The medical topics should be marked as OT.

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Some friendly advice, if you are going to criticize a study you should at very least read the friggin’ study!

Here is a brief description of why your criticisms are baseless with the passages from the study in italics.

The 1,583,028 medicare patients studied in the JAMA paper "were hospitalized in acute care hospitals from January 1, 2011, through December 31, 2014." People dying without seeing a doctor is very sad, but not relevant to this study.

The study controlled for regional biases by statistically comparing male and female physicians from the same hospital. "Model 2 adjusted for all variables in model 1 plus hospital fixed effects (ie, hospital indicators), effectively comparing male and female physicians within the same hospital."

When they did this, 30-day mortality rate for patients with female doctors remained statistically significantly lower (10.91%) than for those with male doctors (11.46%). See Table 2.

Let me summarize and simplify the above to make sure you understand. Patients get sick and are admitted to a hospital. The hospital assigns doctors (hospitalists) to take care of these patients. This is done more-or-less randomly, based on doctor availability. Some doctors are female. Some are male. Significantly fewer patients die within 30 days if they have a female doctor than with male doctors. This is true even when you do the comparisons within the same hospital.

Table 3 is interesting as it shows the mortality data broken down by illness. The patient outcome from female physicians is consistently better than with male physicians.

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Some here may not like it, but those are the numbers. If you are in a casino and learn that red comes up on the roulette wheel 54% of the time, what color should you bet on?

Health care costs are probably the single most important economic issue facing the US. Understanding why female doctors are getting significantly better health care outcomes and having male doctors learn and apply those methods could result in major cost savings and improved care.

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The difference was .55%

Can that be reproduced?

It does not speak to the actual care of anybody which is my objection.

Deciding “Improve health care? More female doctors” is not in the result. Since you asked.

The stretching of statements around the results .55% difference is extreme.

The important thing for you to take away medicine is not statistically based. I get all the studies are. It is not how medicine is practiced.

I do not read the studies because they are not worth anything. MOSTLY.

In this care .55% was totally meaningless. I started there and i end there.

The reason for economic studies of medicine have less to do with the care in the office or ER and more to do with the allocation of care so that 30k underinsured or uninsured Americans do not die every year. Just as importantly so preventative care is better in the US.

In economic terms productivity would rise. Costs would decline with universal care.

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I don’t think any of us find this surprising.

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Most medical doctors would do a hard pass as well.

You are making that into an insult. It is your limited knowledge of the medical world.

You are putting a huge effort and a lot time into .55% difference that probably could not be reproduced and proves nothing.

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Most medical doctors within your own personal (limited?) experience

Whilst most physicians…dentists…veterinarians etc might not spend their time poring over every research paper published, any with an ounce of gumption choose reproducible published data in their decision making. Whether they’re aware of it or not.

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Yes within my extended family and circles of doctors.

Yes, some of it filters down into standards of care, of course.

But this study is a waste of time. .55% is meaningless.

Answering the question of more female doctors? This study made no real difference.

I did not read it and most doctors would give it a hard pass. If you told them upfront the difference was .55% just about every doctor would give it a pass.

What was the statistical margin of error, 1 to 2%?

It is not much more than clickbait regardless of which journal it was in.

The result could be very different a second time just depending on the luck of which gendered doctors got which patients. It was a dice throw.

@VeeEnn outside of yourself the other 5 or 6 doctors on this board rarely contribute to the threads on journal research. Have you noted that? Most entirely avoid it. Most doctors know the statistical research confuses the public. Most doctors know in the office they do not directly put any of it to use unless it is a standard of care.

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And just how does a treatment become standard of care, if it hasn’t been tested against what used to be standard of care? How do we know what are now generally recognised as useless…or worse…treatments and should be retired from the clinical armamentarium without objective testing. Divine Guidance? Appeals to Authority? Personal Experience?

Thinking about one particular change in my clinical sphere where there’s been almost an about face…antibiotic cover in the prevention of bacterial endocarditis. From darn near everyone with a vague history of “heart murmer” to a very few limited clinical situations. This wasn’t determined by anecdote but extensive review of the data. This is probably true with antibiotic usage in general over the past decades and, as is now recognised (from accumulated reproducible data) overuse of antibiotics has the potential to be a big public health problem…with associated costs to Society.

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Yes within the specialty doctors will become experts on the standards of care and most of the research that went into creating the standards.

Then you know how much research in your specialty was set aside for a variety of reasons. I am sure you became efficient at setting poorer ideas aside. There were probably a lot of poorer ideas in the research.

Penicillin was found with anecdotal evidence. Which is a strength if something has to be used one patient at a time.

It is fascinating to me how the history as you cite it of bacterial endocarditis went forward to a better treatment regime. I love those stories and realities in medicine. I could stay here all day reading those ideas.

The doctor’s office in the coming years will get tabletop testing units for bacterial infections that can manufacture or order from the pharmacy antibiotics that are specific, not broad-based.