Is There a Difference in How Women and Men Practice Medicine?

As a definition, medical ethics refers to “a system of moral principles that apply values to the practice of clinical medicine and in scientific research”. The four main principles around which this term centers around is the principle of respect for autonomy, principle of nonmaleficence, principle of beneficence, and principle of justice. These values allow healthcare professionals, care providers, and patients to work towards common goals for the purpose of increasing health awareness and boosting well-being. The practice of medical ethics is widely accepted and practiced on a global level but there are also quite a few other codes of conduct. The Hippocratic Oath is an oath upon which a new physician swears to uphold several professional ethical standards. Throughout the years, the oath has been rewritten in order to better suit the modern times and the values of today’s cultures. While every physician must stay up to date on the latest guidelines, regulations, and doctor ethics pertaining to medicine, one question that continues to linger is whether there is a difference in how women and men practice medicine.

A new study suggests that the answer to this question is yes and reveals that such differences can help patients in terms of fewer preventable deaths and hospital re-admissions. The findings highlight evidence that physician gender does, in fact, influence how medicine is practiced. “The motivation for this was really straightforward. There have been a dozen or so studies looking at practice differences between male and female physicians” said Dr. Ashish Jha, professor of health policy and director of the Harvard Global Health Institute. He continued stating that “women physicians are more likely to practice evidence-based medicine and stick with clinical guidelines, and patients report that women doctors are more highly affective. Do differences in patterns of practice, we wondered, make a difference in outcomes for patients? We wanted to see if it really mattered for patients or not.”

Between 2011 and 2014, Yusuke Tsugawa and fellow researchers analyzed a group of over one million Medicare patients who were hospitalized for 8 diverse medical conditions and who were treated by an internist. “Our study adds that these variations in practice patterns between men and women doctors, which have been reported in other studies, result in meaningful differences in outcomes and [shows] that we have to think seriously about why this is happening” said Tsugawa, research associate at Harvard T.H. Chan School of Public Health.
From the results gathered, female physicians had lower mortality (11.07% vs. 11.49%) and lower re-admission rates (15.02% vs. 15.57%). “Although the difference in patient mortality between male and female physicians was modest, an observed effect size of a 0.43-percentage-point difference or a relative risk reduction of 4% in mortality is arguably a clinically meaningful difference” wrote Tsugawa and his research team. According to their estimations, “given that there are more than 10 million Medicare hospitalizations due to medical conditions in the United States annually and assuming that the association between sex and mortality is causal, we estimate that approximately 32,000 fewer patients would die if male physicians could achieve the same outcomes as female physicians every year” stated the authors.

Their study was based on previous evidence gathered that revealed female physicians tend to be more reassuring, encourage patient-centered communication, ask more psychological questions, and follow clinical practice guidelines. Moreover, an additional study revealed that patients of female physicians had fewer visits to the E.R. than those of male physicians. “I think it is possible that it may not be one clinical practice thing that explains the difference. It may be a combination of all these differences and when you add them all up they result in the findings that we showed” said Tsugawa. Furthermore, he added “this is research that will be really helpful for society and for the healthcare system to make sure that all Americans are getting high-quality medical care.

Cindy L. Grines, doctor at the Detroit Medical Center, commented that the study is fascinating and that is should be taken more seriously, in light of even the smallest percentage of mortality and re-admission rate reductions. “We already know women spend more time with patients, and this actually harms their career and salary, which is often RVU-based. Many female physicians I know state that they always [feel] pressured to be faster and more productive. When reimbursement becomes quality-based, not volume-based, I think that physicians will take the time to be more thoughtful and analytic” said Grines. Tsugawa is hopeful that this research will lead to opportunities where both male and female physicians can learn from one another. “If they practice the exact same way, gender cannot affect patient outcomes. If they sit together and discuss it, they may find out more about how they do things differently and why those things result in a patient outcome that is better” commented Tsugawa.

Still, other growing evidence suggests that despite female physicians seen to be providing high-quality care, interruptions in their careers due to pregnancy, part-time employment, as well as barters between work and home responsibilities, may benefit the forefront of male physicians and justify their higher salaries. On average, male physicians earn $250,000 a year, while female physicians earn $163,000 a year. Yet, female physicians tend to focus more on their patients. “Previous work has shown that female physicians have a more patient-centered communication style, are more encouraging and reassuring, and have longer visits than male physicians. In a system that is increasingly focused on pay for performance, behaviors that lead to improved outcomes are rewarded, which might narrow the pay gap between the genders” said Anna Parks of the University of California. This suggests that perhaps if physicians were to be paid based on better performance; this would help to close the financial gap between men and women.

A study, conducted among Swiss and American researchers, found that patients evaluated both male and female physicians’ concerns for patients in rather different ways. Although male patients tended to be satisfied with their physicians’, regardless of their gender and way of communicating, female patients were more specific in their assessments. They noted that there were more satisfied with female physicians because they expressed greater concern and empathy. “You can’t necessarily say that women are better doctors. It’s a matter of gender behaviors in the course of an encounter. Patients, as well as physicians, are bringing their specific backgrounds and experiences to that encounter; and we need to be aware of that” said Dr. Klea D. Bertakis, professor of family and community medicine at the University of California. Similarly, another study found that male patients were more comfortable with male physicians because most female physicians had chaperones with them during doctor visits. While in some instances, chaperones may make patients feel more at ease; this particular study noted the opposite effect and thereby lead male patients to experience a higher level of uneasiness with female physicians.

For years now, studies have proposed that both men and women practice medicine in different ways. Findings reveal that female physicians are more prone to following clinical guidelines, openly communicating with patients, and advising them on preventative care, as opposed to male physicians. In other words, there is something to suggest that female physicians are doing something different from their male counterparts. Is it that female physicians are better at communicating with patients, thus allowing them to be more efficient in their work? Evidence to date is rather small and whether these differences have a vital impact on patients’ well-being remains vague. The bottom line is that the difference may be small but it is still significant. Therefore, further studies need to be conducted in order to learn more about why such differences exist, how to achieve better professional performance among all physicians, as well as how to achieve better patient outcomes, despite the gender of the physician.