In-hospital mortality lower among patients treated by female physicians

Patients who were treated by female physicians had a lower in-hospital mortality rate than patients who were treated by male physicians, according to results of a retrospective cross-sectional study.

“This difference could not be explained by process of care variables, including imaging tests, laboratory tests or medications prescribed,” Anjali Sergeant, BASc, a medical student at McMaster University in Ontario, told Healio Primary Care.

Sergeant and colleagues analyzed data from 171,625 patients (50.9% women; median age, 73 years) who were admitted to one of seven Ontario general medical wards between April 1, 2010, and Oct. 31, 2017.

The patients were cared for by 172 attending physicians, 118 of whom were men. The median practice duration was 4.3 years for women and 7.4 years for men. There were no significant differences in location of medical training, hospital or specialty between female and male physicians.

The in-hospital mortality rate was 4.8% among patients who were cared for by women and 5.2% among those who were cared for by men. The mortality difference persisted after the researchers adjusted the data for hospital characteristics (adjusted OR [aOR] = 1.11; 95% CI, 1.01-1.23) and patient characteristics (aOR = 1.12; 95% CI, 1.01-1.24). However, the association was no longer statistically significant after adjusting for physician characteristics, including age and years of experience.

“The lower death rate in the patients of female physicians was partially explained by the fact that a higher proportion of new medical grads are female, and new grads may be more up-to-date on clinical guidelines,” Sergeant said.

The researchers found that women performed more imaging tests than their male counterparts, including CT (adjusted difference = 1.70%; 95% CI, 2.78% to 0.61%), MRI (adjusted difference = 0.88%; 95% CI, 1.37% to 0.38%) and ultrasonography (adjusted difference = 1.90%; 95% CI, 3.21% to 0.59%).

They noted several limitations to the study, including the use of in-hospital mortality data rather than 30-day mortality data and the inability to determine physician gender “beyond the binary framing of female and male.”

According to Sergeant, previous research has shown that female physicians spend more time with patients, provide more patient-centered care and more often adhere to clinical guidance. Future studies should consider whether these factors impact patient outcomes, she added.

“Women are clearly performing as well if not better than male colleagues in terms of patient outcomes,” Sergeant said. “The fact that female physicians get paid a fraction on the dollar compared to their male colleagues — evidenced in past literature — seems discordant with the quality of care provided.”