The time a doctor spends listening, the explanations offered at a patient's bedside and the decision to consult a colleague before making a diagnosis: Could differences in how male and female physicians care for hospitalized patients affect their chances of survival?
A major Canadian study involving nearly one million patients found an association between treatment by female physicians and lower mortality rates. The difference was particularly pronounced among female patients. But what explains the gap? The researchers say that question remains unanswered.
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Care by female physicians was associated with lower mortality among hospitalized patients
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Published October 30 in the medical journal JAMA Network Open, the study examined records from 958,150 adults hospitalized in Ontario, Canada, between 2008 and 2022. Their median age was 74.
The patients were admitted for one of seven common conditions: heart attack, heart failure, atrial fibrillation, chronic obstructive pulmonary disease (COPD), pneumonia, stroke or gastrointestinal bleeding.
"This is a large-scale study published in an important medical journal that examined nearly one million hospitalized patients," said Prof. Anat Gafter-Gvili, a specialist in internal medicine and hematology, head of Internal Medicine Department A at Beilinson Hospital, part of Clalit Health Services, and head of Tel Aviv University's medical school.
"The researchers examined whether the sex of the physician primarily responsible for a patient's care during hospitalization was associated with treatment outcomes. They found that patients treated by female physicians had lower mortality within 30 days," she explained.
The difference remained after statistical adjustments
The study included 15,165 physicians, approximately 36% of whom were women. Female physicians were primarily responsible for the care of about 27% of the hospitalized patients.
Researchers defined the primary physician as the doctor responsible for a patient's care for the greatest number of days during their hospital stay.
Prof. Anat Gafter-GviliPhoto: Shlomi YosefBecause patients often receive treatment from several physicians during hospitalization, the researchers also examined the proportion of days each patient spent under the care of a female doctor.
After adjusting for differences involving patients, physicians and hospitals, the researchers found that the adjusted 30-day mortality rate was 12.3% among patients primarily treated by female physicians, compared with 13.7% among those treated by male physicians.
That represented a difference of 1.4 percentage points. The statistical analysis also found that treatment by a female physician was associated with 12% lower odds of death within 30 days.
A similar pattern emerged when researchers examined how much of a patient's hospital stay was spent under the care of female physicians. Every 10-percentage-point increase in the proportion of hospital days managed by a female doctor was associated with 7% lower odds of death within 30 days.
The female physicians in the study tended to be younger, had fewer years of professional experience and treated fewer patients annually than their male counterparts. Their patients, however, were generally older and more likely to be medically frail.
The researchers accounted for these differences, as well as underlying medical conditions, socioeconomic status and previous use of health care services.
The association between treatment by female physicians and lower mortality was observed among both male and female patients, although the difference was greater among women.
Among female patients, the adjusted mortality difference was 1.29 percentage points, compared with 0.75 percentage points among male patients.
The association was also identified in six of the seven diagnostic categories examined. The exception was atrial fibrillation, for which no association was found between physician sex and mortality within 30 days.
‘Listen and give patients room to speak’
The study did not directly examine how medical decisions were made or how physicians communicated with patients.
However, drawing on previous research, the investigators suggested several possible explanations for the differences, including the time doctors devote to patients, their willingness to involve patients in decisions, adherence to treatment guidelines and consultation with colleagues.
Listening to patients may help physicians obtain a more complete picture of their medical history
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"As a physician, these findings are flattering to me and to other female doctors," Gafter-Gvili said.
"From my experience working with female residents and colleagues, women physicians invest a great deal in communicating with patients. They devote time to them and demonstrate patience, concern and empathy," she said.
"I believe that the ability to speak to patients as equals, provide personal and detailed explanations and involve them in decision-making can contribute to their care."
Gafter-Gvili emphasized that listening is also an essential part of the diagnostic process.
"When you give patients time and room to speak, you can obtain a more detailed picture of their medical history and choose the appropriate diagnostic tests accordingly," she explained. "Clear explanations that help patients understand their condition are also very important."
Beyond the relationship between doctor and patient, she highlighted the importance of consultation within medical teams.
"In my experience, female physicians are not afraid to consult colleagues, hold team discussions and listen to additional opinions," she said. "I am very collaborative in my own work, and consultation can help us arrive at a more accurate diagnosis."
She stressed that respectful communication is an integral part of medical education for both men and women.
"Medical training places considerable emphasis on how we approach patients: sitting beside them, looking them in the eye and speaking to them as equals," she said.
What the study still cannot explain
The association between treatment by female physicians and lower mortality was also observed at 90 days and one year after hospitalization when patients were grouped according to the sex of their primary physician. However, the differences became smaller over time.
The findings concerning hospital readmissions were less consistent. Within 30 days, the adjusted readmission rate was 18.6% among patients primarily treated by female physicians, compared with 18.9% among those treated by male physicians.
After 90 days, no statistically significant difference was found. At one year, treatment by a female physician was associated with slightly higher odds of readmission.
Care by female physicians was also associated with longer hospital stays.
For Gafter-Gvili, the findings are encouraging in light of the changing gender composition of medical schools.
"At a time when the proportion of female medical students continues to rise, reaching around 70% at some medical schools, it is gratifying to see results like these," she said.
Nevertheless, the researchers emphasized an important limitation: This was an observational study, meaning it identified an association but could not establish that a physician's sex caused the differences in patient outcomes.
Hospital treatment is also delivered by entire medical teams, and the researchers could not fully account for the contributions of every professional involved in a patient's care. Nor could they directly examine differences in treatment methods or clinical decision-making.
The findings also cannot be generalized to outpatient care, since the study focused exclusively on hospitalized patients.
The researchers called for further studies to determine what might explain the differences and whether particular approaches to patient care could improve outcomes.
Ultimately, the findings raise a question that extends beyond whether a patient is treated by a man or a woman: Which aspects of medical care are associated with better survival, and how can they be incorporated into everyday hospital practice?