Female physicians associated with improved inpatient mortality and readmission rates

1. In this observational study, inpatients treated by a female physician had lower 30-day mortality rates, with female patients benefitting more than male patients.

2. Readmission rates were lower in patients treated by a female physician. 

Evidence Rating Level: 2 (Good)

Study Rundown: Healthcare quality may vary depending on provider and patient sociodemographic factors. It is important to understand the role that differing physician sex has in the care of patients and the disparities they face. To address the gap in prior literature, this study assessed the association between physician sex and important patient outcomes such as mortality and hospital admissions. There were four combinations of patient and physician sex dyads: female patient and female physician, female patient and male physician, male patient and female physician, and male patient and male physician. The two main outcomes of interest were 30-day mortality from the date of admission and 30-day readmission into the hospital from the date of discharge. Along with this, many secondary outcomes were appraised, such as length of stay, health care spending, and discharge to home. Patients receiving care from the same hospital were compared using the effect partitioning approach since several variables may vary across different hospitals. The average marginal effects (AMEs) of being treated by a female physician were calculated separately for male and female patients to allow for better interpretation of the results. As the study population was above the age of 65, the results may not be generalizable to a younger population. Overall, patients had lower mortality rates when treated by a female physician, and those who specifically benefited from a female provider were female patients in the inpatient setting.

Click to read the study in AIM

In-Depth [retrospective cohort study]: To assess if there was a difference between physician sex and hospital outcomes in male and female patients, a retrospective observational study was conducted. Included in the study were individuals aged 65 years or older who had been hospitalized between January 1, 2016, and December 31, 2019, and who had Medicare fee-for-service beneficiaries. The patients had to be hospitalized for a medical condition, and thus, hospitalizations relating to obstetric or surgical MS-DRGs were excluded. A total of 239,965 (30.9%) patients received care from female physicians out of 776,927 patients hospitalized, and 42,114 physicians were included. Furthermore, of the 458,108 female patients, 142,465 (31.1%) were treated by female physicians, and of 318,819 male patients, 97,500 (30.6%) were treated by female physicians. Before adjusting, mortality occurred in 9.08% of participants overall, 8.42% of female patients, and 10.01% of male patients. Female patients had statistically important differences between female and male physicians (adjusted rates, 8.15% for female vs. 8.38% for male physicians; AME, -0.24 percentage points; 95% CI, -0.41 to -0.07). Although male patients also differed between treatment from female and male physicians (10.15% vs. 10.23%; AME, -0.08; 95% CI, -0.29 to 0.14). Thus, female patients benefitted more from receiving care from female physicians than male patients (difference-in-differences, -0.16; 95% CI, -0.42 to 0.10). Overall, the 30-day readmission rate was 15.83%, 15.2% for female patients, and 16.71% for male patients. The difference in having a female or male provider was clinically important for female patients but not for male patients. Similarly, readmission rates were lower for patients treated by a female physician.

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