Do women make better doctors than men?
A recent study in JAMA Internal Medicine claims that they do. According to the authors, there is a 4 percent risk reduction in mortality for elderly patients treated by women. There is also a small but clinically significant reduction in readmission rates. By their analysis, this difference could translate to approximately 32,000 lives saved “if male physicians could achieve the same outcomes as female physicians every year.”
In their discussion of their data, they suggest that female doctors may outperform men due to better communication, attention to detail, or simply because they are smarter (as measured by standardized test performance). These conclusions have received extensive and uncritical media attention. Outlets from the Atlantic to Fox News have restated the authors’ claims with headlines like, “Evidence of the Superiority of Female Doctors” and “Elderly patients live longer when they have female doctors.”
Their conclusions may very well be true. But before we fire every male doctor and kick all men out of medical school, one important finding from this study must be addressed: Female doctors saw on average 37 percent fewer patients than male doctors (131.9 vs. 180.6). This is not a fluke, as this data corresponds with other studies showing that female physicians work fewer hours than male physicians. For example, a 2000 study published in the Journal of General Internal Medicine found that 22 percent of women worked part-time, versus 9 percent for men. More recent data supports the veracity of these findings. According to Medscape’s 2016 compensation survey, only 26 percent of female physicians report spending more than forty hours a week with patients, compared to 40 percent of male doctors.
Both common sense and a wealth of data about the impact of work hours on performance suggest that physicians working fewer hours, and seeing fewer patients, will provide better care for their patients. I strongly suspect that if they were to re-analyze their data for number of patients seen, their reported difference between male and female doctors would vanish. Instead, they would likely see a proportional improvement with patient outcomes as number of patients seen (and hours worked) decreased for both sexes. Even if my hunch is incorrect, this is an essential variable that needs to be analyzed before drawing any conclusions from the data.
However, this notion was not obvious to the authors of this study, who made no effort to control for number of patients seen or hours worked. They also failed to discuss what, if any, effect they think number of patients seen might have had on physician performance. I am not sure why they chose to ignore such a vital piece of data in their conclusions. Perhaps they knew that, given the dire shortage of physicians, suggesting that doctors work fewer hours would be pointless. My more cynical side wonders if they knew that claiming, “Women are better than men” would get more headlines than “Doctors need more time off.”
James Block is a medical student.
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