Are female doctors better than male doctors?

#female #doctors #male #doctors

Welcome to Impact Factor, your weekly dose of commentary on a new study in medicine. I am Dr. F. Perry Wilson, from the Yale School of Medicine, in New Haven, United States.

Today is a battle of the sexes as we dive into an article that makes you say, “Wow, that’s an interesting study” and also “wow, I’m glad I didn’t do that study.” And studies of this type are always somewhat delicate; They say something about medicine, but also about society and that makes this a bit delicate. But that has never stopped us. So let’s try to answer the question: are female doctors better than male doctors?

On the surface this question is almost impossible to answer. It’s too broad: what does it mean to be a “better” doctor? At first glance it seems that there are too many variables to control: type of doctor, type of patient, clinical scenario, etc.

But in this study what compared in-hospital mortality and readmission rates by physician and patient sex, published in Annals of Internal Medicine, A rather ingenious method is used to eliminate all bias by taking advantage of two simple facts:[1] First, today hospital medicine is largely in the hands of hospitalists; Secondly, because their work is based on shifts, which hospitalist you get when you enter a hospital is practically random.

In other words, if you are admitted for an acute illness and are seen by a hospitalist, you have no control over whether they are male or female. Is this a randomized trial? No, but it’s not bad.

Researchers used Medicare claims data to identify adults age 65 and older who had non-elective hospital admissions in the United States. The claims revealed the sex of the patient and the name of the doctor treating him. Through a link to a database of medical providers they were able to determine the sex of the treating physician.

The objective was to analyze the results of four dyads:

• Male patient-male doctor.

• Male patient-female doctor.

• Female patient-male doctor.

• Female patient-female doctor.

The primary endpoint was 30-day mortality.

I already told you that focusing on hospitalists produces some pseudorandomization, but let’s look at the data to be sure. Just under a million patients were treated by 50,000 doctors, 30% of whom were female. And while female and male patients differed, the same was not true regarding the sex of their hospitalist. Thus, based on physician sex, patients were similar in average age, race, ethnicity, family income, Medicaid eligibility, and coexisting illnesses. The authors even created a “predicted mortality” score that was also similar across groups.

Now, female doctors were a little different from male doctors. Female hospitalists were slightly more likely to have an osteopathic degree, had slightly fewer admissions per year, and were slightly younger.

So we have very similar patients, regardless of who their hospitalist was, but hospitalists differ by factors other than their gender. Good.

Here I have graphed the results. The 30-day mortality rate of female patients was significantly lower than that of male patients, but they fared even better when they were seen by female doctors than by male doctors. The sex of the doctor did not greatly influence the results of the male patients. The secondary endpoint (30-day hospital readmission) showed a similar trend.

This is a relatively small effect, no doubt, but if we multiply it by the millions of annual hospital admissions we can start to get real numbers.

So what is going on here? I see four broad groups of possibilities.

Let’s start with the obvious explanation: women, on average, are better doctors than men. I am married to a doctor and from my personal experience, this explanation is undoubtedly true. But why?

The authors cite data indicating that female physicians are less likely than male physicians to disregard patients’ concerns—particularly female patients—which may lead to fewer diagnoses being missed.[2] But this is impossible to measure with administrative data, so this study cannot tell us whether female hospitalists are more attentive than their male counterparts, nor can it indicate that the benefit is mediated by the shorter average height of female doctors. Maybe the key is to be closer to the patient?

The second possibility here is that this has nothing to do with the doctor’s sex at all; It has to do with other things that are associated with the sex of the doctor. We know, for example, that female doctors saw fewer patients per year than male doctors, but the study authors took this into account in the statistical models. Still, there could be other unmeasured factors (confounding factors). By the way, confounding factors would not necessarily change the main conclusion: es Better that women serve you. It’s not because they are women, it is a convenient marker for some other quality, such as age.

The third possibility is that the study represents a phenomenon called collider bias. The idea in this case is that doctors only enter the study if they are hospitalists and the quality of the doctors who choose to be hospitalists may differ depending on sex. When deciding on a specialty, a talented resident who considers certain aspects of his or her lifestyle may find hospital medicine especially attractive, and that attraction toward a more lifestyle-friendly specialty may differ by gender, as has been shown some previous studies.[3] If true, the group of female hospitalists might be better than their male counterparts, because doctors of that caliber don’t become hospitalists.

Well, don’t take note. I’m just trying to cite examples of how to think about collider bias. I can’t prove that this is the case and in fact the authors do a sensitivity analysis of all physicians, not just hospitalists and show the same thing. So it’s probably not true, but epidemiology is fun, right?

And the fourth possibility: this is nothing more than statistical noise. The effect size is incredibly small and right on the edge of statistical significance. Especially when working with very large data sets like this, one must be very careful about overinterpreting statistically significant findings that are nevertheless of small magnitude.

In any case, it is an interesting study that made me reflect and, of course, worry a little about how to present it. Forgive me if I have been indelicate in addressing the complex issues of sex, gender and society here. After all, I’m just a male doctor.

El Dr. F. Perry Wilson, M. S.C. E., (@fperrywilson) is an associate professor of medicine and director of the Yale Clinical and Translational Research Accelerator. His science communication work can be found on the Huffington Post, on NPR, and here on Medscape. His new book, How Medicine Works and When It Doesn’t, It is now available.

This content was originally published in the English edition of Medscape.