Superior Pay for Superior Female Doctors?
Ever since I was a college teacher back in the seventies I have been a advocate for women doctors. I remember trying to convince a particularly brilliant advisee that she should be a doctor rather than a nurse. My primary physician is a woman, and the surgeon for my upcoming surgery is a woman. So I was pleased to come across this article which told me I was correct all along.
The research is published in the journal JAMA Internal Medicine. Researchers from Harvard University reviewed the records of 1,583,028 hospital visits among Medicare patients. Within 30 days of arriving at the hospital, rates of death and re-admission were significantly lower when the patient’s doctor was female.
This was true for people with medical conditions of all sorts and severities. The researchers tried to account for every variable; but ultimately all that was left was the finding that women are superior to men at treating these (65-and-older) patients in the hospital. The association held true even for patients who were randomly assigned to a physician when they arrived. People treated by a female had a 4 percent lower relative risk of dying and 5 percent lower relative risk of being admitted to the hospital again in the following month.I noticed that residency programs where very upset by Trump's travel ban. They have a big competition for these residencies, and there were thousands of applicants from the banned countries.
Now are we running a competition for the best, mostly male I suspect, future physicians from around the world, when in fact we may be neglecting a better source of future physicians, our own women.?
The article in The Atlantic seems to me to have serious problems. I don't think it is being overly critical to point out that the secondary headline ("New research estimates that if all physicians were female, 32,000 fewer Americans would die every year") is basically nonsensical. How could any research estimate what would happen if all US physicians were women?
ReplyDeleteThe article states, "Within 30 days of arriving at the hospital, rates of death and re-admission were significantly lower when the patient’s doctor was female." This is taking statistical averages for male and female doctors and implying that they apply in individual cases unless, of course, it was the case that every patient treated by a female doctor fared better than any patient treated by a male doctor. Such a finding would be remarkable indeed! Presumably there were better and worse male doctors, better and worse female doctors, with some doctors (both male and female) outperforming most other doctors.
The article says, "Still the implication is not that everyone should rush to choose a female physician, discarding males in droves. For one, this would be impractical since females make up only one-third of the American physician work force." It should add, "For another, there is absolutely no evidence in the study that switching from your current male doctor to a female doctor will mean you are getting a better doctor." Switching from a male doctor to a female doctor would guarantee improvement only if the worst female doctor is superior to the best male doctor.
Imagine if this article were written about race rather than gender. Or even imagine if the finding of the study had been that male doctors outperform female doctors. It would unquestionably have been attacked as sexist.
Unfortunately this article is difficult to evaluate because the original research article is behind a paywall. However it did pass peer review by the AMA editor. Perhaps as a social scientist I could find some holes; we are always great at that. Perhaps the author of the Atlantic post misinterpreted it, but I looked at several different posts on the original AMA article and they all said the same thing as this one.
DeleteBy the way this research was made possible by our increasing large computer data bases. I developed and used such large databases for our mental health systems very early on before people elsewhere did. I had a ten year database of Lucas County in the 1980s (it started on a mainframe!), and a ten year database for Lake County in the 1990s.
I found many things that managers and clinicians were completely unaware of. Clinicians can not see the forest for the trees. And the tree they are looking at is not the patient, but the patient's problem.
Now to use these databases you need good researchers which I think the AMA authors are.
I find doctors of both genders about equally disappointing.
ReplyDeleteI had a woman doctor for 13 years, a family practitioner. She moved out of town. I miss her; my husband even liked her. I think it's largely a matter of finding a doctor you trust and are comfortable with. My son and daughter in law found a family doctor they like and who is good with the children. That means they can all go to the same clinic for most of their needs. They have had some hassles when their insurance changed and he wasn't part of their group. But now he is included again. I think it is neat that he takes part in Doctors Without Borders.
ReplyDeleteGender may be less of a problem than corporatization of medicine, which really worries me. I even heard that Mars (yes, the candy bar company) is buying up veterinary practices. Even those small, entrepreneurial entities are being gobbled up.
ReplyDeleteAmen. I retired at age sixty. My golden years were until age 70 when I begin to get an additional diagnosis each year.
DeleteOne of the physician asked me how I was doing in life. I told him that I had spent my professional life trying to get the mental health system to work for the mentally ill, and now I feel I am back at work trying to get the health system to work for me!
I didn't get a primary physician until the new problems developed. She has done a magnificent job of integrating the doctors that I have had a long time, and new doctors at the Cleveland Clinic while dealing with this scientist patient who is very aware of the limitations of Clinicians. She gets high marks.
I suspected a woman might be able to do integration better than most male doctors. Like when I disagree with another physician she will carefully explain why he is doing what he is doing even if she disagrees. In treating all these multiple problems the best strategy has been to get back to basics, exercise, etc. We eliminated two diagnoses and two doctors that way!
I think she deserves a pay raise since we are cutting health care costs.
Jack, being an optical engineer with six diopters of myopia and astigmatism to boot, I guess I kept my opthalmologists on their toes. Strangely, my eyes improved 2 diopters over the past few years. Something actually improved with age. Wow.
ReplyDelete