Total health care costs far lower among patients treated by female vs. male surgeons
Key takeaways:
- Patients treated by female surgeons experienced significantly lower 1-year total health care costs.
- Researchers observed similar lower health care costs at 30 and 90 days after surgery for patients treated by female surgeons.
Patients treated by female surgeons experienced lower heath care costs compared with those treated by male surgeons, according to study results.
The findings, published in JAMA Surgery, add to the growing data that back the creation of inclusive policies and environments supportive of female surgeons to improve recruitment and retention of a more diverse and representative workforce, researchers concluded.
Surgeon sex
“Prior research has shown differences in postoperative outcomes for patients treated by female and male surgeons. It is important to understand, from a health system and payer perspective, whether surgical health care costs differ according to the surgeon’s sex,” Arghavan Salles, MD, PhD, clinical associate professor and special advisor for diversity, equity and inclusion programs in the department of medicine at Stanford University, and colleagues wrote.
Investigators sought to assess the association between surgeon sex and health care costs among 1,165,711 adult patients undergoing one of 25 common elective or emergent surgical procedures in Ontario, Canada, between 2007 and 2019.
Total health care costs assessed 1 year after surgery served as the primary outcome. Secondary outcomes included total health care costs at 30 and 90 days.
Researchers also assessed specific cost categories and used generalized estimating equations with procedure-level clustering to compare costs between patients undergoing equivalent surgeries performed by female vs. male surgeons, further adjusting for patient-, surgeon-, anesthesiologist-, hospital- and procedure-level covariates.
Health care costs
Overall, 151,054 surgeries were performed by a female surgeon and 1,014,657 were performed by a male surgeon.
Results showed higher 1-year total health care costs for patients treated by male surgeons ($24,882; 95% CI, $20,780-$29,794) compared with female surgeons ($18,517; 95% CI, $16,080-$21,324) for an absolute adjusted difference of $6,365 (95% CI, $3,491-$9,238) and an adjusted relative risk of 1.1 (95% CI, 1.05-1.14).
Researchers observed similar results at 30 days (adjusted absolute difference, $3,115; 95% CI, $1,682-$4,548) and 90 days (adjusted absolute difference, $4,228; 95% CI, $2,255-$6,202).
Moreover, results showed higher adjusted relative risk for surgeon sex and inpatient costs (adjusted RR, 1.15; 95% CI, 1.13-1.16) as well as post-discharge continuing care (adjusted RR, 1.08; 95% CI, 1.06-1.11) compared with prescription medications (adjusted RR, 1.04; 95% CI, 1.02-1.06) and physician costs (adjusted RR, 1.08; 95% CI, 1.04-1.12).
After adjusting for surgeon specialty, age, volume or years in practice; hospital status; case complexity; patient age, sex or comorbidity; anesthesiologist age, sex, volume or years in practice or era of surgery, results showed the highest 1-year adjusted total health care costs for male patients treated by male surgeons (adjusted mean cost, $28,869; 95% CI, $23,172-$35,966), followed by male patients treated by female surgeons (adjusted mean cost, $25,050; 95% CI, $18,945-$33,123), female patients treated by male surgeons (adjusted mean cost, $21,751; 95% CI, $17,931-$26,385) and female patients treated by female surgeons (adjusted mean cost, $16,324; 95% CI, $14,311-$18,619).
“Considering the importance of surgical care, these findings may have important health system implications,” the researchers wrote.
Among 1,165,711 patients who underwent 25 different procedures during a 13-year period in Ontario, extrapolation of the per-cost difference between female and male surgeons corresponded to a cost difference of $4.21 billion U.S. dollars in 2020 over 30 days, $5.86 billion U.S. dollars over 90 days, and $9.01 billion U.S. dollars over 1 year.
“In the U.S., annual expenditures for surgical care exceeded USD $120 billion as of 2014,” the researchers wrote. “Thus, the relative difference in total health care costs following surgery between patients treated by female and male surgeons of approximately 10% (adjusted RR, 1.10) demonstrated here represents potentially large cost savings.”
Researchers reported study limitations, including the fact that they captured binary biologic sex and could not assess either patient or surgeon gender. Additionally, researchers could not capture other potentially important aspects of identity, “including race and ethnicity, professional hierarchy, and disability, or other potentially important unmeasured physician sociocultural factors, individual characteristic traits, unconscious bias and communication styles.”
Additional work
“This large, population-level cohort study found significantly lower short- and long-term costs of care for patients treated by female surgeons compared with male surgeons,” Salles and colleagues wrote. “These data ... justify work to better understand the personality traits and practice behaviors that underpin these sex-based differences in outcomes. Together, these actions are vital for offering the highest value care for all patients undergoing surgery.”
Perspective
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This work is incredibly important for a variety of reasons. Research in the past has shown that there are differences in postop outcomes for patients who are treated by surgeons of different genders, and that is obviously important for clinical outcomes. This study actually looked at the gender of the surgeon and health care costs among patients undergoing surgery. So, obviously, a different way of looking at how a surgeon gender impacts delivery of care.
The really interesting finding in this study was that they found lower 30-day, 90-day and 1 year health care costs for patients who are treated by female surgeons compared with those treated by male surgeons, which really goes to show why it is so important to continue to advocate for equity in the health care space.
We talk about women surgeons being equally competent, when we really shouldn’t even have to quantify or qualify that. But unfortunately, because of the health care landscape, many times surgeons who are not of male gender are questioned. Their expertise is questioned simply because they are female. We are seeing more and more studies and data come out showing that these female surgeons have better overall outcomes — have lower mortality and morbidity. Now this study is showing that surgeons also save hospitals money and save health care costs. This truly goes to show the real benefit to getting more women into these surgical specialties when, in the past many, women were recommended not to. It is a sad state of affairs that we have to actually justify these types of things. We shouldn’t have to justify why women should be doctors; we shouldn’t have to prove that women are just as competent as their male colleagues. But unfortunately, that is the world we currently live in.
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