Medical Care blog

Comments from the scientific community regarding Medical Care.

Thursday, January 28, 2016

The intersection of physician gender and quality of care

By Gregory D. Stevens, PhD, MHS

According to data out this month from the Kaiser Family Foundation, there are 2 male doctors for every 1 female in practice in the US. This translates to about 300,000 fewer women than men in practice today. This gender difference is a disparity that many in health care may think has resolved, but in fact has smoldered rather quietly for years.

A recent study by Dahrouge and colleagues (published on Medical Care’s website on January 13, 2016) adds some fuel to the fire. Analyses of nearly 4,200 family doctors and 6.3 million patients in Ontario, Canada suggest that the gender disparity may hurt quality of care. The authors found that patients of female doctors were more likely to get the right preventive care and have better management of diabetes and congestive heart failure (if they had one of those conditions). They were also less likely to visit a hospital or emergency room during the study period.

The authors are cautious in offering explanations. If the results are generalizable—and studies dating back to the early 1990s, such as this one, suggest they might be—the policy prescriptions are complicated.

The authors (and others) offer variations on the idea that female doctors may take more time with patients, be more attuned to what patients want, or use clinical guidelines more often. (Are men more devil-may-care in this regard? Interesting idea, but at least one study suggests not.) It is also likely that patients respond differently to female and male doctors based on their own comfort, perceived empathy, and trust.

In my own work on primary care among patients with diabetes, only women reported benefitting—in terms of health and quality of life—from receiving higher quality primary care. We wondered whether women might have made better use of the time they spent with their doctors (for example, by asking more questions during visits). We didn’t consider the gender of the doctor, which now seems an oversight.

One obvious policy prescription we might draw from these findings is that more women should be encouraged to enter medicine, particularly primary care. However, the US has already seen increasing numbers of women in medicine. In 2014, women made up roughly 47% of all medical school graduates, although this still amounts to more than 900 fewer women than men graduating. Women also make up larger percentages in particular specialties, such as obstetrics/gynecology (85% female), pediatrics (75%), and family medicine (58%), and there are more than 2 female physician assistants for every male.

A second approach might be to observe how encounters with female doctors are actually different from encounters with male doctors and see what lessons can be drawn for male providers. A third is to push harder for the use of clinical guidelines across the board.

These are not easy issues. The work of Dahrouge and colleagues reminds us of the need to extinguish the flames, rather than let these gender disparities in quality continue to smolder.

Gregory D. Stevens, Ph.D., MHS is health policy researcher, writer, teacher and advocate. He is an Associate Professor of Family Medicine and Preventive Medicine at the Keck School of Medicine of the University of Southern California.