A provocative study from Canada has found patients who consult a female gastroenterologist have lower use of the healthcare system in the following two years compared to those seen by a male doctor.
The researchers analysed the subsequent healthcare use of 2.7 million patients living in Ontario following an initial consultation with a gastroenterologist (15% seen by female gastroenterologists and 85% seen by male gastroenterologists).
Findings revealed that patients seen initially by a female gastroenterologist had significantly lower rates of ED visits (RR 0.89), primary care visits (RR 0.93) and hospitalisations (RR 0.80) compared to those seen by a male gastroenterologist.
The effects were more pronounced for female patients, who were 16% less likely to visit the ED, 10% less likely to visit their GP, and 23% less likely to be admitted to hospital compared to 7%, 7% and 11% respectively for male patients seeing a female gastroenterologist as opposed to a male gastroenterologist.
Writing in Gastroenterology [link here], the researchers said their findings pointed to differences in practice patterns between female and male gastroenterologists that might be influenced by societal gender norms but had clinical implications.
They postulated that female gastroenterologists may provide more conscientious care and use more shared decision-making than their male peers, which had positive effects on patient autonomy, self-management and ultimately outcomes.
“If female gastroenterologists, like their female colleagues in primary care and internal medicine, place similar emphasis on proactive, preventative care, this may partially explain their patients’ lower frequency of ED visits, primary care visits, and hospitalisations,” the researchers said.
“Broadly, female physicians seem to be on average more patient-centred in their care, which patients want; yet such care is undervalued, takes more time, and is not financially incentivised by the healthcare system.
“These physician qualities that constitute ‘patient-centred care’ are not innate in women; rather, they are preferentially cultivated in women as a result of societal norms and stereotyped gender roles. That is to say, the ability to provide more patient-centred care is a broadly learnable skill.”
The researchers added that endoscopic skills tended to be the focus in gastroenterology training, whereas there was less teaching and feedback around patient communication skills, which tended to be learned “on the job”.
“Through GI-specific communications curricula, both male and female GI trainees can learn how to more effectively and efficiently express empathy, establish rapport, manage expectations, and encourage shared decision-making with their patients,” the researchers said.
While there had been similar findings in other areas of medicine including internal medicine, primary care and cardiology, the researchers noted some limitations.
Namely, they could not rule out the possibility that the lower healthcare use for patients of female gastroenterologists could be due to systematic channeling of more complex patients towards male physicians, although they tried to account for this.