The findings confirm other studies that show differences in the practice patterns between male and female physicians.
All things being equal, if you’re older and in the hospital, your odds improve if your doctor is a woman.
That’s what a study of more than 1.5 million Medicare claims has found, according to results published Monday in JAMA Internal Medicine. The study, which involved older patients—the average age was 80.2 years—found that those treated by female doctors had lower 30-day mortality rates and lower 30-day readmission rates, both key metrics as Medicare moves toward basing more reimbursement on quality measures.
While the mortality differences were modest, they were still meaningful, and they build on other evidence that is clinically important, say the authors from Harvard’s T.H. Chan School of Public Health and Massachusetts General Hospital. The claims covered January 2011 to December 2014.
“Taken together with previous evidence suggesting that male and female physicians may practice differently, our findings indicate that potential differences in practice patterns between male and female physicians may have important clinical implications for patient outcomes,” they wrote.
Female internists had lower mortality and readmission rates than their male counterparts across a host of conditions, and after adjusting for several physician factors. Besides the lower overall adjusted rate of 30-day mortality (11.07% for women versus 11.49% for men), and a lower adjusted 30-day readmission rate (15.02% vs 15.57%), female physicians had lower mortality rates for sepsis (23.05% versus 25.09%), pneumonia (10.11% versus 11.03%), acute renal failure (12.54% versus 13.30%) and arrhythmia (5.08% versus 6.02%). Other conditions where women physicians recorded lower mortality rates, though not statistically significant ones, included congestive heart failure and urinary tract infections.
The study’s look at older Medicare patients, a fast-growing population, was also important. “Given that there are more than 10 million Medicare hospitalizations due to medical conditions in the United States annually and assuming that the association between sex and mortality is causal, we estimate that approximately 32,000 fewer patients would die if male physicians could achieve the same outcomes as female physicians every year,” the authors wrote.
Researchers took pains to tease out whether the findings could be pinned on male doctors taking care of sicker patients, including one step that weeded out medical intensive care units, as male internists are more likely to work here. Because the study was limited to hospitalists—who specialize in treating admitted patients—the researchers found a population where patients had less ability to select their physician.
“We found that nearly all observable characteristics typically associated with illness severity were well balanced between the male and female physicians,” they wrote. “Even for hospitalist physicians, among whom patients are plausibly more likely to be randomly assigned, we found that patient characteristics were balanced between male and female physicians, and that patients of female physicians continued to have lower patient mortality and readmission rates.”
What’s more important, the researchers write, is why the female physicians produced better results. Other studies suggest women may be more likely to practice evidence-based care, and they may be more deliberate in solving complex cases. In this study, women were more likely to have osteopathic training, and they treated fewer patients in the hospital per year.
“Understanding exactly why these differences in care quality and practice patterns exist may provide valuable insights into improving quality of care for all patients, irrespective of who provides their care,” they wrote.
Tsugawa Y, Jena AB, Figueroa JF, et al. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians [published online December 19, 2016]. JAMA Intern Med. doi: 10.1001/jamainternmed.2016.7875.