Gender flap, resolved: Female, male physicians on par in resource use

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Research suggests that female physicians provide more patient-centered care than their male counterparts. Does that translate into more or less use of healthcare resources such as office visits or hospital use? Neither, according to a recently published study.

Previous research by Klea D. Bertakis, MD, MPH, of the University of California Davis School of Medicine, found that female physicians provided a significantly greater amount of patient-centered care than did male physicians, with the greatest concordance seen in female patient-female physician situations (J Womens Health [Larchmt] 2012 March; 21[3]: 326–333). With UC Davis colleague Anthony Jerant, MD, as the lead author, Bertakis and others looked at the association of the gender of a patient’s physician and healthcare utilization and mortality.

They reasoned that patient-centered communications by female physicians during office visits might help to better identify patients’ concerns and expectations, which could influence resource use. For instance, physicians might be less inclined to order tests or refer a patient to specialists; or patients might feel empowered to schedule more office visits to address other previously neglected health issues.

Jerant et al analyzed data from a nationally representative sample of the U.S. National Medical Expenditure Panel Surveys (MEPS) between 2002 and 2008 to study the association between the gender of the patient’s usual source of healthcare in one year and use of resources such as office visits, emergency department visits, hospitalizations and expenditures in the next year. They also linked MEPS data to the National Death Index to examine the association between provider gender and all-cause mortality.

Of the 25,743 adult patients who reported the gender of their physician, 83 percent had completed data that included healthcare use. In an adjusted analysis, female provider status was associated with patients being younger, female and from urban regions. Being a female provider was not associated with usage outcomes or mortality.

Men and women providers showed no differences between the first and second year of care in five unadjusted usage measures: Mean total healthcare expenditures ($5,320 for male vs. $5,150 for female physicians); prescription drugs expenditures ($1,240 vs. $1,200); office visits (5.09 vs. 5.05); emergency department visits (15.1 percent vs. 14.6 percent); and any hospitalization (10.9 percent vs. 10.1 percent).

“These findings suggest practice styles associated with USOC [usual source of healthcare] gender are unlikely to have an effect on healthcare use and mortality,” Jerant et al wrote. They added the study was not designed to explain mechanisms behind the findings, but suggested two possible answers: Optimal patient-centered practices and outcomes don’t translate into measurable effects on healthcare use and mortality; or care-seeking behaviors that motivate patients to select female physicians may cancel out gains from optimal patient-centered practices.

“Such competing influences, which may be partly dependent on the specific clinical context, could result in no significant net effect of female USOC on these outcomes, at least when examined in a broadly representative sample,” the researchers wrote.

The study relied on self-reported MEPS data, which may be subject to bias, but the authors emphasized that patients likely correctly reported the gender of their physicians. It was published in the March-April issue of the Journal of the American Board of Family Medicine.