Comparison of Hospital Mortality and Readmission Rates for Medicare Patients Treated by Male vs Female Physicians

Abstract

IMPORTANCEStudies have found differences in practice patterns between male and female physicians, with female physicians more likely to adhere to clinical guidelines and evidence-based practice. However, whether patient outcomes differ between male and female physicians is largely unknown. OBJECTIVE To determine whether mortality and readmission rates differ between patients treated by male or female physicians. DESIGN, SETTING, AND PARTICIPANTSWe analyzed a 20% random sample of Medicare fee-for-service beneficiaries 65 years or older hospitalized with a medical condition and treated by general internists from January 1, 2011, to December 31, 2014. We examined the association between physician sex and 30-day mortality and readmission rates, adjusted for patient and physician characteristics and hospital fixed effects (effectively comparing female and male physicians within the same hospital). As a sensitivity analysis, we examined only physicians focusing on hospital care (hospitalists), among whom patients are plausibly quasi-randomized to physicians based on the physician's specific work schedules. We also investigated whether differences in patient outcomes varied by specific condition or by underlying severity of illness. MAIN OUTCOMES AND MEASURES Patients' 30-day mortality and readmission rates.RESULTS A total of 1 583 028 hospitalizations were used for analyses of 30-day mortality (mean [SD] patient age, 80.2 [8.5] years; 621 412 men and 961 616 women) and 1 540 797 were used for analyses of readmission (mean [SD] patient age, 80.1 [8.5] years; 602 115 men and 938 682 women). Patients treated by female physicians had lower 30-day mortality (adjusted mortality, 11.07% vs 11.49%; adjusted risk difference, -0.43%; 95% CI, -0.57% to -0.28%; P < .001; number needed to treat to prevent 1 death, 233) and lower 30-day readmissions (adjusted readmissions, 15.02% vs 15.57%; adjusted risk difference, -0.55%; 95% CI, -0.71% to -0.39%; P < .001; number needed to treat to prevent 1 readmission, 182) than patients cared for by male physicians, after accounting for potential confounders. Our findings were unaffected when restricting analyses to patients treated by hospitalists. Differences persisted across 8 common medical conditions and across patients' severity of illness. CONCLUSIONS AND RELEVANCEElderly hospitalized patients treated by female internists have lower mortality and readmissions compared with those cared for by male internists. These findings suggest that the differences in practice patterns between male and female physicians, as suggested in previous studies, may have important clinical implications for patient outcomes.

Are Women Really Better Physicians Than Men Are?

“…Researchers at Harvard School of Public Health designed a study 17 to determine whether mortality and readmission rates differ for patients treated by male or female physicians. Accessing a random 20% sample of US Medicare beneficiaries 65 years and older, hospitalized with any of 8 most common medical conditions (acute renal failure, arrhythmia, chronic obstructive pulmonary disease, gastrointestinal bleeding, heart failure, pneumonia, sepsis, urinary tract infection), and treated by general internists from January 1, 2011, to December 31, 2014, Tsugawa et al 17 examined the association between physician sex and 30-day mortality and readmission rates.…”

“…Accessing a random 20% sample of US Medicare beneficiaries 65 years and older, hospitalized with any of 8 most common medical conditions (acute renal failure, arrhythmia, chronic obstructive pulmonary disease, gastrointestinal bleeding, heart failure, pneumonia, sepsis, urinary tract infection), and treated by general internists from January 1, 2011, to December 31, 2014, Tsugawa et al 17 examined the association between physician sex and 30-day mortality and readmission rates. After adjusting for patient and physician characteristics and hospital-related effects and considering only physicians who were hospitalists, they also investigated patient outcomes relative to specific conditions and to severity of illness.…”

“…After adjusting for patient and physician characteristics and hospital-related effects and considering only physicians who were hospitalists, they also investigated patient outcomes relative to specific conditions and to severity of illness. 17 A total of 58 344 general internists were included; of these, 18 751 (32.1%) were female. More than 1.5 million hospitalizations were analyzed.…”

Eru konur betri læknar en karlar?

“…1 Yfir ein og hálf milljón innlagna voru skoðaðar í handahófskenndu úrtaki og sérstaklega skráð dánartíðni og tíðni endurinnlagna. Í ljós kom að dánartíðni sjúklinga kvenkyns laekna var marktaekt laegri en þeirra sjúklinga sem höfðu karlkyns laekni, 11,07% á móti 11,49%, p<0,01, eða hlutfallsleg áhaettuminnkun upp á 4%.…”

Letter to a Young Female Physician

“…4 The publication of that finding prompted much speculation about why it might be so: perhaps women are more intuitive, more empathic, more attentive to detail, better listeners, or even kinder? I don't know whether any of those generalizations are true, but my personal experience and observations make me sure of this: when women do possess these positive traits, we tend to discount their significance and may even consider them liabilities.…”