Why Patients Treated by Female Doctors Are Less Likely To Die
In the doctor’s office gender does matter, yet another study finds
The Noösphere is an entirely reader-supported publication that brings the latest social sciences research into frequently overlooked topics. If you read it every week and value the labour that goes into it, consider becoming a paid subscriber! You can also buy me a coffee instead.
In 1869, the dean of the Woman’s Medical College of Pennsylvania proudly brought her students to the Saturday teaching clinics at the Pennsylvania Hospital.
For years, she had been seeking permission for them to observe the clinicians at work. But when managers finally agreed, the female students didn’t exactly receive a warm welcome. Droves of male medical students turned out in front of the hospital to harass, verbally abuse and throw items at their passing female peers — including paper, tinfoil, and… ‘tobacco juice’ — which later came to be known as The Jeering Episode.
Just a year later, in 1870, a similar incident occurred in Edinburgh when a small group of female medical students — including Sophia Jex-Blake, the first practising female doctor in Scotland — were violently harassed by a mob of men while on their way to sit an anatomy exam. But this was just the culmination of months of abuse levelled at them.
Women in medicine have struggled with acceptance for a very long time — although they have always existed, even when they were almost entirely excluded from formal practice — thanks to the bioessentialist belief that they aren’t ‘naturally’ wired for a medical role like men are.
As one piece in the medical journal The Lancet in 1878 claimed:
Woman as a doctor is a conceit contradictory to nature, and doomed to end in disappointment to both the physician and the sick.
But while things have improved since a ‘lady’ doctor was as unimaginable as a flying pig, the debate whether women truly belong in medicine and can be trusted as physicians, surgeons and other health professionals sadly continues. Some people even still seem to be convinced that women can never become as good at it as men.
And yet study after study suggests something quite different.
I doubt any of this will come as particularly surprising to women.
After all, recent surveys show that nearly half of us already prefer being treated by a female doctor, while most men don’t have a preference in the matter, and less than a quarter say they prefer male doctors.
However, according to a new study by The University of California, Los Angeles (UCLA), published in the journal Annals of Internal Medicine, both women and men have better outcomes when treated by a female physician. After analysing more than 775,000 medical insurance claims between 2016 and 2019 for more than 458,000 female and over 319,000 male patients, the researchers found a meaningful mortality gap between those treated by female versus male doctors within 30 days of being seen by them.
The mortality rate for female patients treated by female doctors was 8.15% compared to 8.38% when the doctor was male. This means that for every 1,000 patients treated, an extra two would be expected to survive if a woman treated them.
The difference for male patients was less pronounced, but female doctors still had the edge with a 10.15% mortality rate compared with male doctors’ 10.23%. That’s a difference of roughly one death in a 1,000.
Moreover, the researchers also found the same pattern for hospital readmission rates. Commenting on the study, Dr Yusuke Tsugawa, one of the study’s authors and professor at the David Geffen School of Medicine at the University of California, said:
What our findings indicate is that female and male physicians practice medicine differently, and these differences have a meaningful impact on patients’ health outcomes.
But this is hardly the only recent study that finds women do indeed make pretty good doctors. Just a few months ago, two new studies out of Canada and Sweden made rounds on the internet, suggesting that patients operated on by female surgeons fare better than those operated on by male surgeons.
The Canadian study, published by the American Medical Association’s journal JAMA Surgery and conducted on more than 1 million patients in Ontario, Canada between 2007 and 2019, found that one year after surgery 25% of patients treated by a male surgeon experienced adverse post-operative outcomes, and 2.4% died. In comparison, and within the same period, 20.7% of patients treated by a female surgeon experienced similar negative outcomes, and 1.6% died.
The Swedish study, published in the same journal and conducted among 150,000 patients using data from the Swedish Registry of Gallstone Surgery found, similarly, that patients under the care of female surgeons experienced fewer complications and shorter stays in the hospital following the operation.
Previous studies have also shown that women are 32% more likely to die if a male rather than a female surgeon carries out the surgery and that they’re more likely to survive a heart attack if they are treated by a female doctor than a male one.
Clearly, women in medicine must be doing something differently than men, as Dr Tsugawa points out, leading to better patient outcomes and even fewer deaths.
But what is it, exactly?
One theory as to why female doctors might be better at treating women is that male doctors are more likely to dismiss women’s pain and symptoms, which then leads to a higher chance of misdiagnosis and worse medical care. Women and minority patients are up to 30% more likely to be misdiagnosed than white men, another recent study found.
Women are also less likely to be prescribed effective painkillers and receive intensive care but more likely to report having negative experiences with health care and having their concerns and symptoms dismissed or ignored than men.
Well, the medical industry as a whole has a long history of dismissing, ignoring and minimising women’s health issues, which is also linked to the fact that up until the early 90s, women’s bodies were largely excluded from medical research and, to some extent, still are today. Medicine’s perpetuation of women’s ‘natural’ inferiority and the myths surrounding our bodies — like the idea that our wombs ‘wander’ from time to time, rendering us insane— certainly didn’t help either.
But, clearly, it’s not just female patients’ chances of survival and receiving the proper treatment that improve if treated by female doctors.
It’s male patients, too.
The team behind the recent UCLA study suggested this could be due to female doctors communicating better with their patients, making it likelier they would provide important information that leads to better diagnoses and treatment.
Other studies indeed suggest that female doctors show more empathy than male doctors, spend more time with their patients — which might lead to better care but also means they see fewer patients and earn less — and, overall, incorporate a more patient-centred practice style that can minimise the amount of miscommunication and misunderstanding.
I don’t think it’s a coincidence, though, that what makes female doctors stand out seems to be greater empathy, compassion and effective communication — the socioemotional traits typically considered ‘feminine.’ Women are socialised to excel at care and to be other-oriented, nurturing, empathetic and compassionate practically from the moment we’re little girls.
Is it then really surprising that in medicine, a field where caring and communicating well — on top of a few other qualities — are critical to ensuring the best outcomes for patients, women are doing better than men?
Interestingly, the study that investigated women’s heart attack survival rates found that it’s not just female doctors that improve their chances. It’s also male doctors who have a lot of female colleagues in their team. Could these traits have a spillover effect? Perhaps. Dr My Blohm of Stockholm’s Karolinska Institute, who co-authored the Sweden study, also pointed out that the gendered differences in surgical outcomes could be due to lower risk-taking behaviours in women.
But if what really drives the variation between women and men doctors is the difference in socialisation between the genders, then there’s no reason to believe men can’t lean into these ‘feminine’ qualities, too.
Clearly, traits once dismissed as ‘inferior’ and useful only in the private sphere prove quite valuable in the public one.
And medicine is hardly the only field where this can be observed.
You might be familiar with the phenomenon of ‘male flight,’ which happens when men leave an occupation or activity once women begin participating in it in more significant numbers. And as sociologist Paula England has found in her research, the more feminised an industry becomes, the lower its perceived importance, prestige and, consequently, average pay.
But while this doesn’t seem to be taking place in medicine (and let’s hope it never will) despite women increasingly taking a bigger share of its workforce, I do think there’s something else that tends to happen when women flock to a previously heavily male-dominated field.
In farming, for instance, studies show that when women increasingly own or operate farms this has a positive spillover effect on their community wellbeing — including lowering poverty rates and extending life expectancy — but also on the neighbouring communities. As Claudia Schmidt, lead author of a study on this topic, pointed out, that’s because ‘women farmers tend to enter into farming for different reasons than men and often make decisions with the greater good in mind.’
In politics and corporate environments, on the other hand, a greater number of women in decision-making positions within government and large companies’ boards of directors have been linked to lower rates of corruption and overall improved transparency.
And, as several studies on patients outcomes suggest, having more female doctors can lead to lower mortality rates and improved patient care.
There does seem to be an overall beneficial spillover effect when a field becomes feminised. Perhaps it should be described as a separate phenomenon — the ‘female spillover.’
Now, none of this is to say women should take over the world and men should retreat to the caves. However, I do think we need to pause and consider what this data tells us and why there’s a difference in how women and men perform in various professions.
Of course, there are other factors at play here, but gendered expectations of behaviour likely matter, too.
You’d really think that qualities like empathy, compassion and being caring and community-minded shouldn’t be framed as strictly ‘feminine’ or ‘masculine,’ just things all humans should value and prioritise whenever applicable. But they sadly still are.
Instead of being thrown tobacco juice in their faces — literal or metaphorical — women should be encouraged to enter professions that were previously only reserved for men. Not only because we should have the same opportunities as men but also because we all benefit from diversity.
Just like we’d all benefit from having more people embracing previously demonised ‘feminine’ traits.
In particular, considering that our world and the people leading it seem to be going in the opposite direction now.
I wonder if there's also an effect that since the field used to be male dominated, the women that do end up becoming doctors are better than their male colleagues, because you have to counter the negative bias.
I wrote about a similar issue in workplace discrimination - basically, minority employees at stores performed between with minority managers, but performed worse with white managers (and also worse with more prejudiced managers). So on average both groups, minority employees and white employees, performed identically, it turns out that minority employees attached to the right manager would outperform everyone (https://www.nominalnews.com/p/housing-rental-discrimination)
I've been disabled since '01. Retired doc (M) assessed me for disability, "How long have you been hurting?" Me boiling, "Since 19 fucking 52" - "Oh." I just couldn't force my body to ignore the pain anymore.
Just got a new doctor (F), my previous one (M) moved (to be clear, he was great). 2nd appt renewing Rx. She asks about my pain at the moment and I rattled off my current issues. Her response was unique, "I'm so sorry" - didn't expect that. Might be the only time 'cause I cannot recall any other.
Yeah, in general my women PCPs were more engaged than the men. I have some specialists that are men, and they appear to understand how the patient deals with whatever they are specialized in. Male PCP - not so much. With the last one being an exception.