Variations in Processes of Care and Outcomes for Hospitalized General Medicine Patients Treated by Female vs Male Physicians

Abstract

IMPORTANCE Hospitalized medical patients cared for by female physicians may have decreased mortality rates compared with patients of male physicians. However, this association has yet to be assessed outside of the US, and little is known about factors that may explain this difference.OBJECTIVE To determine whether mortality, other hospital outcomes, and processes of care differed between the patients cared for by female and male physicians. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study included patients admitted to general medical wards at 7 hospitals in Ontario, Canada, between April 1, 2010, and October 31, 2017. The association of physician gender with patient outcomes was examined while adjusting for hospital fixed effects, patient characteristics, physician characteristics, and processes of care. All patients were admitted to a general internal medicine service through the emergency department and were cared for by a general internist or family physician-hospitalist. Patients were excluded if length of stay was greater than 30 days or if the attending physician cared for less than 100 hospitalized general medicine patients over the study period. Statistical analyses were performed from October 15, 2020, to May 8, 2021. MAIN OUTCOMES AND MEASURESIn-hospital mortality, length of stay, intensive care unit admission, 30-day readmissions, and process-of-care measures (blood tests, medications, imaging, endoscopy, and interventional radiology services). RESULTSA total of 171 625 hospitalized patients with a median age of 73 years (interquartile range, 56-84 years) were included (84 221 men [49.1%], 87 402 women [50.9%], and 2 patients with unspecified sex). Patients were cared for by 172 attending physicians (54 female physicians [31.4%] and 118 male physicians [68.6%]). In fully adjusted models, female physicians ordered more imaging tests, including computed tomography

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“…In our study, we identified an overall mortality rate of 7.8%, which is higher than what has been reported in other Canadian studies 5 14. One Canadian centre found that an institution-wide mortality of 3.3%, with 18.7% of cases reviewed having opportunities for improvements in care 5.…”

“…In Canada, GIM is a specialty that involves diagnosing and managing complex, polycomorbid, seriously ill patients suffering from advanced illness and/or diseases affecting more than one organ system. In-hospital mortality rates among hospitalised patients in Canada have been reported to range between 3.3 and 5% 5 14. Given that at an average-sized, urban, tertiary care centre in Canada, a GIM admitting service would be expected to have a per annum caseload of several thousand, conducting routine mortality reviews of all patient deaths would be a significant time commitment.…”

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“…Recipients of weekly electronic table of 4 differences in hospital care and outcomes for general medical patients treated by female and male physicians in Ontario, Canada, 5 and the distribution of expenditures for insulin among various organizations in the pharmaceutical supply chain (Table ). 6 The wide reach of the JAMA Network has already been highly beneficial for JAMA Health Forum authors.…”

“…During 2021, 844 manuscripts from authors in 31 countries were submitted to JAMA Health Forum , including 588 research manuscripts and 256 opinion manuscripts (Table). The manuscript acceptance rate was 21% overall and 18% for research manuscripts (Original Investigations, Research Letters, and Special Communications).…”

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