Female physicians order more imaging than men, produce lower mortality rates
Female physicians order more imaging exams than male colleagues but appear to produce lower mortality rates, according to a new analysis published Friday in JAMA Health Forum.
The findings come from a study of nearly 172,000 patients treated across seven Canadian hospital during a seven-year period. Women general-medicine experts ordered more CT, MRI and ultrasound scans, a difference that persisted when adjusting for various factors, researchers found.
Fewer patients died under women docs’ watch, but this finding was “nonsignificant” after accounting for physician traits such as age, experience, etc., University of Toronto internist Fahad Razak, MD, and colleagues concluded.
“Evidence from previous studies suggests that female physicians perceive clinical risks more highly and, perhaps as a result, order more tests and request more referrals than their male counterparts,” Razak et al. wrote July 16. “In line with this hypothesis, we found that female physicians ordered more diagnostic CT, MRI, and ultrasound imaging tests than male physicians. However, the frequency and type of diagnostic tests ordered by physicians did not attenuate the difference in mortality rate. These findings raise the question: What drives the lower mortality rate in patients of female physicians?”
To reach their conclusions, Ontario scientists ran a cross-sectional study, utilizing data from a more than seven-year snapshot of time ending in October 2017. They included information from hospitals across Canada’s most populated province, taking part in the General Medicine Inpatient Initiative focused on improving care quality. Scientists analyzed metrics including in-hospital mortality, length of stay, intensive care unit admission, 30-day readmissions, imaging orders and use of interventional radiology services.
A total of 171,625 hospitalized patients met the study criteria, with a median age of 73. They were cared for by 172 attending physicians, 54 female (or 31%) and 118 male (69%). After adjustments, women docs ended up ordering CT scans for nearly 54% of patients compared to 52% among men, ultrasound in 11% (10% for men), and ultrasound in 31% (vs. 29%). They also had a higher median cost per admission at almost $4,700 compared to $4,400. Use of X-rays, endoscopies, interventional radiology procedures and several other services did not differ significantly.
Meanwhile, patients treated by female docs had a lower in-hospital mortality rate at 4.8% compared to 5.2% among men, which persisted when adjusting for patient characteristics such as sex. However, modifying for physician traits — i.e., age, years of experience and location of medical training — the variation was no longer statistically different, Razak and colleagues determined. They noted that gender-mediated behavioral differences that are difficult to measure may have played a role in explaining the mortality difference. Previous studies have found female docs more likely to provide patient-centered care, spend longer time communicating with patients, give nonverbal feedback and show higher levels of empathy, the authors noted.
They cautioned readers not to draw conclusions from their work or perpetuate stereotypes, emphasizing the need for additional investigation.
“Future research should seek to validate these findings and explore additional processes of care and behaviors of physicians that may explain differences in patient mortality associated with physician gender,” the authors concluded.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.