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December 19, 2016

Women in Medicine and Patient OutcomesEqual Rights for Better Work?

Author Affiliations
  • 1Department of Internal Medicine, University of California, San Francisco
  • 2Editorial Fellow, JAMA Internal Medicine
  • 3Editor, JAMA Internal Medicine
JAMA Intern Med. Published online December 19, 2016. doi:10.1001/jamainternmed.2016.7883

If you are aware of the disparities between genders in academic medicine, recent publications show multiple areas with opportunities for improvement. Jena and colleagues1 found that female physicians in academia were less likely than their male counterparts to have reached the rank of full professor (11.9% vs 28.6%). Serge et al2 reported that start-up funding packages—which help launch faculty careers—were 67.5% higher for men than for women ($980 000 vs $585 000). Finally, Jena and colleagues3 reported that salaries for female academic physicians are $19 879, or 8.0%, lower than those of their male colleagues.

Among the myriad rationalizations for these disparities between the genders in academic medicine, some have suggested that the burden of home responsibilities, leave for childbearing, or part-time schedules might undermine the quality of female physicians’ work and explain male physicians’ higher salaries. In this issue of JAMA Internal Medicine, Tsugawa et al4 find that the evidence shows the opposite for all internists, not just those in academia, as detailed above.

The group examined data from hospitalized Medicare patients and found that patients treated by female internists fared better than patients treated by male internists, with lower 30-day readmissions (15.02% vs 15.57%) and lower 30-day mortality (11.07% vs 11.49%).4 The differences persisted across 8 medical conditions ranging from arrhythmia to sepsis. Improvements in mortality were strongest for the most severely ill patients. A sensitivity analysis restricted to hospitalists, to whom patients were presumably randomly assigned, found no difference in the severity of illness for patients according to physician gender and confirmed better outcomes for patients treated by female physicians.

We support investigation of practice patterns that mediate improved clinical outcomes. Tsugawa et al4 suggest that these improved outcomes may be the result of female physicians’ greater reliance on clinical guidelines, but such adherence does not always equate with quality or value of care,5 so additional attributes should be examined. Previous work has shown that female physicians have a more patient-centered communication style, are more encouraging and reassuring, and have longer visits than male physicians.6,7 In a system that is increasingly focused on pay for performance, behaviors that lead to improved outcomes are rewarded, which might narrow the pay gap between the genders. Moreover, these findings that female internists provide higher quality care for hospitalized patients yet are promoted, supported, and paid less than male peers in the academic setting should push us to create systems that promote equity in start-up packages, career advancement, and remuneration for all physicians. Such equity promises to result in better professional fulfillment for all physicians as well as improved patient satisfaction and outcomes.

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Article Information

Corresponding Author: Anna L. Parks, MD, Department of Internal Medicine, University of California, San Francisco, 505 Parnassus St, San Francisco, CA 94143 (anna.parks@ucsf.edu).

Published Online: December 19, 2016. doi:10.1001/jamainternmed.2016.7883

Conflict of Interest Disclosures: None reported.

Jena  AB, Khullar  D, Ho  O, Olenski  AR, Blumenthal  DM.  Sex differences in academic rank in US medical schools in 2014. JAMA. 2015;314(11):1149-1158.
Sege  R, Nykiel-Bub  L, Selk  S.  Sex differences in institutional support for junior biomedical researchers. JAMA. 2015;314(11):1175-1177.
Jena  AB, Olenski  AR, Blumenthal  DM.  Sex differences in physician salary in US public medical schools. JAMA Intern Med. 2016;176(9):1294-1304.
Tsugawa  Y, Jena  AB, Figueroa  JF, Orav  EJ, Blumenthal  DM, Jha  AK,  et al.  Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians [published online December 19, 2016]. JAMA Intern Med. doi:10.1001/jamainternmed.2016.7875
Boyd  CM, Darer  J, Boult  C, Fried  LP, Boult  L, Wu  AW.  Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294(6):716-724.
Roter  DL, Hall  JA, Aoki  Y.  Physician gender effects in medical communication: a meta-analytic review. JAMA. 2002;288(6):756-764.
Chen  P. Do women make better doctors? New York Times. May 6, 2010. http://www.nytimes.com/2010/05/06/health/06chen.html. Accessed October 3, 2016.