Understanding practice differences between men and women and applying them in clinical settings can have very real consequences. But don't take the data too personally, says one researcher.
Female physicians are better than males.
That's the essence of the findings of Harvard researchers, distilled by headline writers and social media users. The study was published in JAMA Internal Medicine in December.
Senior study author Ashish Jha, MD, MPH, is more nuanced in his assessment of the findings.
"Modest but clinically important" is how he, a professor of health policy at the Harvard School of Public Health, describes the roughly half-percent difference in mortality and readmission rates of Medicare patients treated by male versus female physicians shown in a study of 1.5 million hospital visits throughout the United States.
Jha spoke with HealthLeaders Media recently about what healthcare leaders can learn from these findings, which suggest that male physicians could save 32,000 lives per year if they practiced more like their female counterparts. The following transcript has been lightly edited.
HealthLeaders Media: What made you want to research this topic?
Ashish Jha, MD: There are a dozen or so studies out there that suggest that women physicians are more likely to practice evidence-based medicine (EBM), more likely to stick to clinical guidelines, and that they communicate more effectively with patients than male physicians do.
We wondered simply whether all of this translates into better outcomes.
HLM: What's the response been like so far?
Jha: There's been a range, from people who are not surprised to those who are very skeptical. It's been mostly male physicians who are skeptical, but there are many male physicians who have been very supportive.
The key here is not to take the findings too personally.
Obviously I'm a male physician and I think it's quite possible for male physicians to be quite terrific. I think people have to look at this more in terms of what it teaches us about how to provide high-quality care as opposed to turning it into a battle of the sexes.
HLM: What have been the skeptics' specific criticisms?
Jha: People have brought up that short of a randomized controlled trial, you can never be 100% sure of a finding.
But we're not going to do a randomized controlled trial, and we see lots of policy decisions made without them. There hasn't been a randomized controlled trial that shows that smoking causes lung cancer, but we know it does.
So while the evidence here is not perfect, it's pretty compelling if you look at the size of the data sets we examined and all of the ways in which we tried to make sure we were finding something real and not just a statistical fluke.
HLM: What can healthcare leaders, including physicians, take from these findings to improve outcomes overall?
Jha: In our study, we couldn't figure out the exact mechanism by which women had better outcomes. But if you look at the broader set of data that is out there, and if we really can draw some conclusions around women's tendency to practice more EBM or communicate more effectively, those are very translatable skills.
Those are things that everybody can do better. The key lesson here is to try to really identify why it is that women seem to achieve better outcomes and then figure out how to translate that more broadly so that all patients have good outcomes irrespective of the gender of physicians.
HLM: With physician reimbursement becoming more closely tied to outcomes, do you expect we'll see the pay gap between male and female physicians close?
Jha: While the pay gap is very problematic, it's not clear to me that the measures that we're using for changing the way we pay physicians are going to necessarily help close the pay gap.
I do think we need a renewed focus to ensure that the gender pay gap, which has been very clearly documented, is addressed effectively. And the fact that women are actually achieving better outcomes should certainly give us yet one more impetus to make that happen.
Debra Shute is the Senior Physicians Editor for HealthLeaders Media.