Do women make better doctors than men?

Recent research comparing female and male physicians makes for fascinating reading

I am naturally wary of ‘battle of the sexes’ topics in medicine – not least because I am an older white male in a rapidly changing profession.

However, a paper just published in the British Journal of Surgery suggests that surgery outcomes are better in hospitals with higher surgery team sex diversity. The Canadian researchers investigated adult patients who had major elective inpatient surgeries between 2009 and 2019 to measure post-operative major morbidity. They found that of 709,899 surgeries performed at 88 hospitals during the period, 90-day major morbidity occurred in 14.4 per cent.

Hospitals where more than 35 per cent of surgeons and anesthesiologists were women had better post-operative outcomes. In these hospitals, patients experienced a three per cent reduction in the odds of major complications within 90 days after surgery.

Until now, there has been limited evidence for the value of teams ‘sex-diversity’ in healthcare. Most published reports have focused on individual characteristics and their associations with outcomes (for example, how female patients respond to female physicians). There is limited data regarding the role of sex-diversity on healthcare teams and their outcomes.

Team sex-diversity likely contributes to patient outcomes through the many differences that male and female doctors bring to the workplace. The researchers pointed out both sexes possess different skills, knowledge, experiences, beliefs, values, and leadership styles.

Lead author Julie Hallet said: “Ensuring a critical mass of female anesthesiologists and surgeons in operative teams isn’t just about equity; it seems necessary to optimise performance. We wanted to challenge the binary discourse of comparing female and male clinicians and rather highlight the importance of diversity as a team asset or bonus in enhancing quality care.”

Well said. However, the comment did not dissuade yours truly from looking for research to answer the question: Do women make better doctors than men?

And so I found another recent paper titled ‘Comparison of hospital mortality and re-admission rates by physician and patient sex,’ which appeared in the Annals of Internal Medicine. This study minimised bias on the basis that: Firstly, hospital medicine is largely conducted by hospitalists; and secondly, due to the shift-based nature of hospitalist work, the hospitalist you get when you are admitted to the hospital is, at the very least, a form of pseudorandomisation.

Researchers used Medicare claims data to identify adults over the age of 65 who had non-elective hospital admissions across the US. Nearly one million patients were treated by approximately 50,000 physicians. Of these physicians, almost a third were female.

What did the results show? Female patients had a significantly lower 30-day mortality rate than male patients and their outcomes were even better when they were treated by female doctors rather than male doctors. Physician sex did not strongly affect outcomes for male patients. A similar pattern was observed for the secondary outcome of 30-day hospital re-admission.

There is one obvious explanation for the research results. They suggest that women, on average, are better doctors than men. I have a daughter who is a doctor, and based on my personal experience, this explanation is undoubtedly true.

Responders to an article in Medscape about the findings came up with the following questions: Do women spend more time with patients and is that significant in terms of outcome? Is patient compliance affected by the sex of the physician, or are women more likely to make a correct diagnosis, or treat appropriately? Are woman physicians likely to be younger and more recently out of training? Is there an optimal duration of practice for hospitalists to provide optimal results?

The authors reference data indicating that female physicians are less likely than male physicians to dismiss patient concerns, particularly those of female patients, potentially resulting in fewer missed diagnoses. Alternatively, the results might not be directly related to the physician’s sex, but rather to other factors associated with it.

And maybe the results don’t meet statistical relevance. The effect size is small and just on the border of statistical significance.

But it’s a fascinating topic. All of us, regardless of sex, would prefer to be less likely to re-admitted or to die after a hospital admission. So further research into the subject is welcome.