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Key Points

Question  Do patient outcomes differ between those treated by male and female physicians?

Findings  In this cross-sectional study, we examined nationally representative data of hospitalized Medicare beneficiaries and found that patients treated by female physicians had significantly lower mortality rates (adjusted mortality rate, 11.07% vs 11.49%) and readmission rates (adjusted readmission rate, 15.02% vs 15.57%) compared with those cared for by male physicians within the same hospital.

Meaning  Differences in practice patterns between male and female physicians, as suggested in previous studies, may have important clinical implications for patient outcomes.

Abstract

Importance  Studies have found differences in practice patterns between male and female physicians, with female physicians more likely to adhere to clinical guidelines and evidence-based practice. However, whether patient outcomes differ between male and female physicians is largely unknown.

Objective  To determine whether mortality and readmission rates differ between patients treated by male or female physicians.

Design, Setting, and Participants  We analyzed a 20% random sample of Medicare fee-for-service beneficiaries 65 years or older hospitalized with a medical condition and treated by general internists from January 1, 2011, to December 31, 2014. We examined the association between physician sex and 30-day mortality and readmission rates, adjusted for patient and physician characteristics and hospital fixed effects (effectively comparing female and male physicians within the same hospital). As a sensitivity analysis, we examined only physicians focusing on hospital care (hospitalists), among whom patients are plausibly quasi-randomized to physicians based on the physician’s specific work schedules. We also investigated whether differences in patient outcomes varied by specific condition or by underlying severity of illness.

Main Outcomes and Measures  Patients’ 30-day mortality and readmission rates.

Results  A total of 1 583 028 hospitalizations were used for analyses of 30-day mortality (mean [SD] patient age, 80.2 [8.5] years; 621 412 men and 961 616 women) and 1 540 797 were used for analyses of readmission (mean [SD] patient age, 80.1 [8.5] years; 602 115 men and 938 682 women). Patients treated by female physicians had lower 30-day mortality (adjusted mortality, 11.07% vs 11.49%; adjusted risk difference, –0.43%; 95% CI, –0.57% to –0.28%; P < .001; number needed to treat to prevent 1 death, 233) and lower 30-day readmissions (adjusted readmissions, 15.02% vs 15.57%; adjusted risk difference, –0.55%; 95% CI, –0.71% to –0.39%; P < .001; number needed to treat to prevent 1 readmission, 182) than patients cared for by male physicians, after accounting for potential confounders. Our findings were unaffected when restricting analyses to patients treated by hospitalists. Differences persisted across 8 common medical conditions and across patients’ severity of illness.

Conclusions and Relevance  Elderly hospitalized patients treated by female internists have lower mortality and readmissions compared with those cared for by male internists. These findings suggest that the differences in practice patterns between male and female physicians, as suggested in previous studies, may have important clinical implications for patient outcomes.

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Article Information

Accepted for Publication: October 13, 2016.

Corresponding Author: Yusuke Tsugawa, MD, MPH, PhD, Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, 42 Church St, Cambridge, MA 02138 (ytsugawa@hsph.harvard.edu).

Published Online: December 19, 2016. doi:10.1001/jamainternmed.2016.7875

Author Contributions: Dr Tsugawa had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Tsugawa, Jena, Jha.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Tsugawa, Jena, Jha.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Tsugawa, Orav.

Administrative, technical, or material support: Jha.

Study supervision: Jena, Jha.

Conflict of Interest Disclosures: Dr Tsugawa reported being supported in part by St Luke’s International University. Dr Jena reported receiving consulting fees unrelated to this work from Pfizer Inc, Hill Rom Services Inc, Bristol Myers Squibb, Novartis Pharmaceuticals, Vertex Pharmaceuticals, and Precision Health Economics, a company providing consulting services to the life sciences industry. No other disclosures were reported.

Funding/Support: Dr Jena was supported by the Early Independence Award, grant 1DP5OD017897-01, from the National Institutes of Health.

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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