Ask the Doctors

Dear Doctor: Do hospitalized patients really get better care from female doctors compared to men, as a new study -- and now many headlines -- claim?

Dear Reader: My initial reaction when I saw this study was one of denial. As a man, I viewed the study -- and the host of media articles reporting on it -- with something like hostility; it seemed no less than an attack on my gender. After I calmed down a bit, I read through the research.

The study, published recently in JAMA Internal Medicine, looked at a random sample of data -- totaling more than 1.5 million hospitalizations -- from four years of hospitalizations among Medicare patients being cared for by general internists. The authors separated the patients into two groups based on the gender of their physicians, then evaluated quality of care by the death rates of these patients within a 30-day period after hospitalization and also by the rates of readmission to the hospital after being discharged.

The authors found that the death rates of patients cared for by female internists were slightly lower than the death rates of patients cared for by male internists: 11.07 percent versus 11.49 percent. This was not a staggering difference -- amounting to one fewer death in 233 patients -- but still, it was a difference. Further, readmission rates were lower for patients of female doctors compared to patients of male doctors: 15.02 percent versus 15.57. This means one fewer readmission in 182 patients.

Even as a man playing devil's advocate, I can't blame confounding factors -- differences in patient characteristics -- for the findings. Female doctors took care of more female patients, slightly fewer patients with heart disease, lung disease and diabetes, but slightly more patients with kidney disease. But these were only minimal differences, and the authors took those differences into account, making adjustments for them in their findings.

Yet there were two differences between the female and male doctors that may be of substance: the physicians themselves. Female physicians in the study were on average 5 years younger than their male counterparts (42.8 years versus 47.8 years). Not to be ageist, but younger doctors may have a greater ability to use hospital computer systems, may be more likely to utilize social services for their patients, and may be more willing to alter their practices based on the latest studies.

Another important aspect is that female physicians on average took care of fewer hospitalized patients than their male counterparts, with female internists taking care of an estimated 132 hospitalized patients per year versus male internists' 181. The busier schedule of the male internists may increase the chances that some aspects of care will be negatively affected. The authors tried to correct for both the age and patient load issues, but that's not easy to do.

As provocative as this new study is, it's far from conclusive. A 2013 study in the Journal of the American Board of Family Medicine found no differences in care between male and female physicians in the rates of death, hospitalizations or health care expenditures.

In summation, this research does nonetheless offer a reminder to all physicians, regardless of gender or age, that many factors affect patient death rates and readmissions -- and we can't afford to let any of them fall through the cracks.

Tomorrow, my colleagues Dr. Glazier and Dr. Ko will cover this study.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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