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Comment & Response
July 2017

Limitations Concerning the Association of Physician Sex and Patient Outcomes

Author Affiliations
  • 1Department of Medicine, Queen’s University, Kingston, Ontario, Canada
  • 2Department of Critical Care Medicine, Queen’s University, Kingston, Ontario, Canada
  • 3Kingston General Hospital, Kingston, Ontario, Canada
JAMA Intern Med. 2017;177(7):1056. doi:10.1001/jamainternmed.2017.2124

To the Editor In their Original Investigation in a recent issue of JAMA Internal Medicine, Tsugawa et al1 reported on an association between physician sex and patient outcomes, based on an analysis of very large administrative and social networking data sets. An important limitation of this study is the method used to link physicians with hospitalization events, which was based on attributing the care episode to the doctor accounting for the majority of that episode’s cost. This attribution assumes that the amount of care provided is directly proportional to spending. Given the importance of care transitions,2 one could argue that the hospitalization should instead be attributed to the physician in charge at the time of admission or even more so at the time of discharge, who may have a greater impact on 30-day outcomes. On average, the physician to whom care was attributed was responsible for just 51.1% of spending, leaving open the question of whether they were responsible at the time of either admission or discharge. This slim majority of spending also suggests that in cases where only one other physician was involved in the hospitalization, care would have been almost evenly shared.

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