“It’s rare that I’ve read a study that made me feel defensive. Until now.” So wrote former rheumatologist and Harvard Health Publishing senior editor Rob Shmerling seven years ago, responding to research that found that patients at US hospitals were less likely to die when treated by female doctors.

Such defensiveness may be bubbling up among some male doctors after another study has come to the same conclusions. Researchers analysed the records of over 750,000 patients in the US aged 65 or older who had been hospitalised and treated between 2016 and 2019. They found that when women were treated by female doctors, they were less likely to die compared to those treated by men. Women treated by women saw a mortality rate of 8.15%; whereas women treated by men saw a rate of 8.38%.

Although this might not sound like much of a difference – and it’s important to note that it isn’t, at the individual level – as the paper’s authors point out, these are meaningful differences at the societal level “given more than 4 million Medicare hospitalizations per year for a medical condition in the United States”. Assuming half of those hospitalisations are women, these findings imply that
out of these 2 million, 4,796 more women would survive each year if male doctors achieved the same outcomes as female doctors. Interestingly, male patients also saw better results under female doctors, although in this case the results weren’t statistically significant (mortality rates of 10.15% vs. 10.23%).

Back in 2017, Shmerling’s initial response to such findings was that there must be some other reason: “The researchers must have missed something,” he wrote, then admitting: “But after reading the research report’s results carefully, it’s hard to come up with an alternative explanation.”

Others working on this question have reported similarly prickly responses when they publicise their research. My Blohm is a surgeon who has published
on gendered differences in surgical outcomes in Sweden. She told me: “When it comes to gender-based research, the initial response tends to be scepticism and many immediately dismiss the findings as untrue.” Chris Wallis, another surgeon looking at this question, reports the same. And the President of the Royal College of Surgeons in England recently apologised for “gaslighting” female surgeons in the way he discussed two papers showing that patients operated on by women were less likely to experience complications than those operated on by men.

So do women really make better doctors than men? Is this even a useful question? And how should we respond?

Here’s The Evidence

The evidence overwhelmingly indicates that on average, there are differences in the way that male and female doctors work, with life or death results. Although all of these studies are observational, and as such cannot determine cause and effect, the data is robust and the papers are stacking up.

In Florida, female heart attack patients were found to be more likely to die when treated by male doctors. In Canada, researchers found that patients seen by female primary care doctors had fewer emergency department visits and subsequent hospitalisations than those seen by men. Another Canadian study looked at surgery outcomes for over 100,000 patients and found that those
treated by female surgeons were slightly less likely to die or experience complications compared with those treated by men. Similar results were found in Sweden. Research in Japan found that female surgeons tended to operate on patients with higher risk, with no negative result in mortality rates.

Most experts haven’t been surprised by the latest findings, and point towards other studies shedding light on several factors that could be driving such differences.

Women are more likely than men to have their pain and cardiovascular symptoms underestimated, their concerns dismissed, and to experience delayed diagnoses for a variety of conditions. Experts say therefore that male doctors may be more likely to underestimate the severity of female patients’ illnesses. In addition, research going back decades has shown that female doctors are more likely than male doctors to follow clinical guidelines, spend more time on consultations, better communicate and build stronger rapport with patients.

Blohm, the surgeon who looked at outcomes in Sweden, told me: “female surgeons tend to achieve better results despite operating more slowly, suggesting that caution may be a favourable quality.” Despite this, she laments, “gender inequalities in healthcare persist even in the most equal countries,” particularly in surgery. Wallis, speaking to the New York Post, noted: “Both more widely in society and certainly in medicine, women are held to arguably a higher standard than men. This is an exaggerated phenomenon in surgery and may explain some of the differences we’ve seen there.”

As all this demonstrates, what’s of interest here are the behaviours that lead to better results, not whether your doctor is a man or a woman. As Wallis says, the explanation of what’s going on here is not “chromosomal”. Study author Yusuke Tsugawa agrees: this doesn’t mean “patients should choose female physicians over male physicians”, he says. Instead, such research should be viewed as an opportunity for all of those working in healthcare to better understand what works best, and adapt patient care accordingly.

Seen in this light, framing the issue as “women are better than men” is not only inflammatory, it’s downright unhelpful. It distracts us from looking at the underlying dynamics and thereby building better healthcare systems that work for all.

I spoke to Geordan Shannon, a doctor and global health expert who authored a Lancet review on gender equality in global health, to find out more.

“We are all responsible”

“We tend to boil these questions down to what you might call identity politics, or binary framings, which are oversimplified and create polarisation or antipathy. But this is not about women versus men,” she told me. “It’s about the broader systems and institutions that uphold patient-doctor interactions. We are all responsible, in our own ways.”

Shannon stresses that it’s important to remember that where it exists at all, we haven’t seen gender equality in healthcare until very recently, and that women in the sector often still don’t have a supportive institutional environment. Gender pay gaps are found across the world in all specialities, and although women comprise the majority of the health workforce, they are massively underrepresented in leadership and management.

Women, then, have it worse off, but produce better outcomes for patients. Why? Shannon finds it interesting to consider the late anthropologist David Graeber’s theory that structures of inequality produce “lopsided structures of the imagination”. “If you’re not in power,” Shannon says; “if you’re at the bottom of the hierarchy – you have to do a lot of emotional labour and imaginative work to try and predict and preempt the needs of those who are”.

« This happens with race. It happens with gender. It happens with poverty, and so forth. Wealthier white men, for example, probably just don’t have the same need for employing that kind of imaginative labour, because they are often in positions of privilege. This type of emotional work tends to be done by women more than men. »

In other words, if you’re used to putting yourself in others’ shoes, perhaps you’re more likely to understand the need for better communication, or that others’ bodies might work differently from the default male, or to avoid making assumptions. And, Shannon continues, “there is evidence to suggest that women spend a little bit more time with their patients and employ more patient-centred communication. Women also tend to take on more unpaid and care work relative to men, so this may also be a factor.”

What is certainly clear is that a more diverse and supported workforce will supply better quality care, encourage better communication practices, allow underrepresented groups to feel seen, and offer a much needed diversity of role models for future doctors. And, perhaps, encourage everyone to practise a little more imagination.

As such, the policy responses mirror feminist solutions across the board: we need to be supporting women and other underrepresented groups achieve equal pay to their male counterparts, to reach positions of leadership, and to work in environments that are conducive to their needs. This would not only allow women to flourish and produce even better results, but would also help out their male colleagues, who, Shannon stresses, “benefit a lot from gender equitable and diverse environments”.

Back in 2017, Shmerling agreed. “One thing is certain,” he concluded: “Accepting the possibility that female physicians may outperform male physicians in certain aspects of medical care, and then trying to understand why, is much more constructive than being defensive about it.”

Research Round-up

Here’s what else is making the news in gender inequality research:

1. 🙇‍♀️ New research involving 9,141 women from across the world has shown that in the run up to menopause, women have a 40% higher risk of developing depression than premenopausal women, highlighting the urgent need for better mental health support.
2. 🏳️‍⚧️ Analysis of hundreds of parliamentary debates and thousands of media reports have shown how transgender rights, feminism, and LGBTIQ+ advocacy are being systematically attacked in European politics and media.
3. 🩸 A new evaluation of female health apps such as period trackers
   found that the vast majority are exposing users to serious privacy and safety risks thanks to their totally inadequate privacy practices.

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About The Evidence

The Evidence is a brand new supplement to the Impact newsletter designed to help you understand gender inequality – and show how we might fix it. Impact is a weekly newsletter of feminist journalism, dedicated to the rights of women and gender-diverse people worldwide.

This is the English version of our newsletter; you can read the French one here.