Women doctors' elderly patients less likely to die

Elderly patients who are cared for by a female physician when hospitalized are less likely to die or to be readmitted than similar patients whose physicians are men, Harvard researchers have found.

"These findings suggest that the differences in practice patterns between male and females physicians, as suggested in previous studies, may have important clinical implications for patient outcomes," Yusuke Tsugawa, MD, MPH, PhD and colleagues wrote in JAMA Internal Medicine.

The researchers analyzed a 20% random sample of Medicare fee-for-services patients who were hospitalized with a medical condition and treated by general internists. The study period was Jan. 1, 2011 to Dec. 31, 2014.

They looked at 30-day mortality, readmission rates, then they adjusted to effectively compare female and male physicians with the same hospital.

The data showed that the adjusted mortality rate for patients treated by female internists was 11.07% vs. 11.49% for those treated by their male counterparts.

There was a similar disparity in readmission rates, or 15.02% for patients with female doctors and 15.57% for those with male doctors.

A possible explanation could be that the women doctors were more likely to adhere to clinical guidelines, "provide preventive care more often, use more patient-centered communication, and provide more psychological counseling," the authors said.

Their study was also designed to build a case for better pay for women.

In an accompanying editorial, Anna Parks, MD and Rita Redberg, MD, MSc, noted that salaries for female academic physicians are about $19,879 lower, or 8.0% less than those of male colleagues.

They also cited studies that showed that women doctors "are more encouraging and reassuring, and have longer visits than male physicians," and that ironically the very behaviors that lead to these better patient outcomes are discouraged by pay-for-performance initiatives that stress increasing the volume of patient encounters in a given day.

The editorial writers said the study findings should be used to "promote equity in start-up packages, career advancement, and remuneration for all physicians."

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Yusuke Tsugawa, MD, Anupam B. Jena, MD, Jose F. Figueroa, et al.  Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians. JAMA Intern Med. Published online December 19, 2016.

Key Points

Question  Do patient outcomes differ between those treated by male and female physicians?

Findings  In this cross-sectional study, we examined nationally representative data of hospitalized Medicare beneficiaries and found that 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.

Meaning  Differences in practice patterns between male and female physicians, as suggested in previous studies, may have important clinical implications for patient outcomes.

Abstract

Importance  Studies have found differences in practice patterns between male and female physicians, with female physicians more likely to adhere to clinical guidelines and evidence-based practice. However, whether patient outcomes differ between male and female physicians is largely unknown.

Objective  To determine whether mortality and readmission rates differ between patients treated by male or female physicians.

Design, Setting, and Participants  We analyzed a 20% random sample of Medicare fee-for-service beneficiaries 65 years or older hospitalized with a medical condition and treated by general internists from January 1, 2011, to December 31, 2014. We examined the association between physician sex and 30-day mortality and readmission rates, adjusted for patient and physician characteristics and hospital fixed effects (effectively comparing female and male physicians within the same hospital). As a sensitivity analysis, we examined only physicians focusing on hospital care (hospitalists), among whom patients are plausibly quasi-randomized to physicians based on the physician’s specific work schedules. We also investigated whether differences in patient outcomes varied by specific condition or by underlying severity of illness.

Main Outcomes and Measures  Patients’ 30-day mortality and readmission rates.

Results  A total of 1 583 028 hospitalizations were used for analyses of 30-day mortality (mean [SD] patient age, 80.2 [8.5] years; 621 412 men and 961 616 women) and 1 540 797 were used for analyses of readmission (mean [SD] patient age, 80.1 [8.5] years; 602 115 men and 938 682 women). Patients treated by female physicians had lower 30-day mortality (adjusted mortality, 11.07% vs 11.49%; adjusted risk difference, –0.43%; 95% CI, –0.57% to –0.28%; P < .001; number needed to treat to prevent 1 death, 233) and lower 30-day readmissions (adjusted readmissions, 15.02% vs 15.57%; adjusted risk difference, –0.55%; 95% CI, –0.71% to –0.39%; P < .001; number needed to treat to prevent 1 readmission, 182) than patients cared for by male physicians, after accounting for potential confounders. Our findings were unaffected when restricting analyses to patients treated by hospitalists. Differences persisted across 8 common medical conditions and across patients’ severity of illness.

Conclusions and Relevance  Elderly hospitalized patients treated by female internists have lower mortality and readmissions compared with those cared for by male internists. These findings suggest that the differences in practice patterns between male and female physicians, as suggested in previous studies, may have important clinical implications for patient outcomes.