In an ongoing effort to improve the quality and continuity of care, researchers have been exploring how individual differences such as gender and age influence the patient experience and clinical outcomes. Your own experience may suggest what this research tells us: women practice medicine differently than men. While men and women practitioners are more similar than they are different, understanding differences in how men and women practice medicine can highlight strengths and opportunities not only for each gender, but what practices and behaviors lead to improved clinical outcomes and build trusting relationships that enhance continuity of care. Practice differences between genders are compelling, as they exist despite the rigors of medical training and existence of standards for care. Even small biases and tendencies can influence clinical outcomes and the patient’s experience and willingness to continue with care and treatment. Knowing what behaviors are linked to these outcomes can provide guidance on hiring and training.
We have substantial knowledge about how men and women differ in providing patient care that can be summarized in the four key areas below.
1. Patient Satisfaction. Female patients give physicians of the same gender greater satisfaction ratings. In looking at the facets of care, women trust female physicians more and believe they showed greater concern for their well-being. Men, however, rate physicians of both genders equally overall and on all facets of care.
2. Focus. Although female and male physicians spend the same amount of time with a patient, female physicians engage more in preventive services and counseling, while male physicians spend more time on history taking, the physical examination, and discussions about treatment. Female physicians are more likely to demonstrate patient-centered behaviors that communicate respect and provide opportunities for patients to be involved in their healthcare journey. Interestingly, for each act of patient-centered care they exhibit, male physicians receive a greater pay-off in patient satisfaction.
3. Relationship Building. Female physicians exhibit more empathy and engage in more positive talk, partnership-building, question-asking, and information-giving compared with their male counterparts. This difference helps to explain the greater ability of female physicians to build consensus and commitment with patients about treatment. With respect to personality differences, female physicians on average are higher in openness to experience ‑ a personality trait linked to relationship building behaviors ‑ that make patients more comfortable in sharing their ideas and observations.
4. Evidence-Based Medicine. On average, female physicians show a slightly greater drive for accuracy than men. This could be linked to slight differences in risk-taking between the genders. Women are more risk-averse and are more likely to leverage all resources to make sure they make the right decision. Possibly because of this difference, researchers found women are more likely to consult clinical guidelines, use checklists, and leverage multiple sources of information in practicing evidence-based medicine. Some research suggests this greater attention to detail is also linked to higher patient satisfaction and reviews.
The important question is: do gender differences in how physicians practice medicine meaningfully influence patient outcomes? Answering this question was the focus of a 2016 study published in the Journal of the American Medical Association. Mortality and readmission rates for close to 60,000 hospitalized Medicare patients were analyzed by physician gender. The results: patients treated by a female physician had a 4% lower relative risk of dying and a 5% lower relative risk of readmission. To put this in context, if the results of the study are applied to all hospitalized patients, 32,000 fewer patients would die each year if male physicians were able to achieve the same outcomes as female physicians. This is close to the number of people who die annually in car accidents.
A single study, however, is not proof of a meaningful difference as all research has limits. For example, while the sample included in this study was large, it was also narrow, focusing on a unique population of elderly, hospitalized, non-surgical patients. Results for hospitalized surgical patients or outpatients may be different. One of the most important caveats: each patient included in the study was assigned to only one physician; the one that accounted for the greatest amount of Medicare Part B spending during the hospital stay. This is concerning as multiple physicians contribute to the quality and continuity of care for each hospitalized patient. The results of the study could mean care teams led by women are linked to improved outcomes. Indeed, how gender influences team dynamics is worth further investigation.
What is the take-away from this research? Clearly, this research does not support excluding men from medicine. In fact, gender differences are not as meaningful as knowledge of what practices and behaviors may improve quality care and patient commitment. By focusing future research on what strategies can be used to improve relationships with patients and the patient experience, powerful hiring and training programs can be developed to improve patient care. Further, additional research would allow us to understand the key personality traits, skills, and abilities that drive these differences. This knowledge could allow the creation of targeted programs to:
- Direct medical students into the best specialty based on their strengths
- Guide physicians to appropriate development programs
- Allow healthcare organizations to hire based on their vision for care and patient experience
Intriguingly, this research echoes recent urgent calls to improve patient-driven care and the importance of physician relationship-building, service, and even hospitality in enhancing continuity of care. Female physicians emphasize building consensus and relationships with patients and more strictly follow an evidence-based approach to treatment. There is some evidence that this tendency leads to greater patient satisfaction, at least for female patients. The 2016 study found a preliminary link to improved patient outcomes by female physicians for elderly, inpatient care.
While gender difference research is preliminary, there is stronger evidence demonstrating the link between personality traits like openness and conscientiousness to greater patient satisfaction and adherence to evidence-based medicine. This suggests the importance of a little-used evidence-based approach to hiring and talent, as well as identifying the personality traits and qualities that affect performance in specific physician roles and organizations.
For example, while a moderate degree of risk aversion is associated with following evidence-based medicine, high levels of risk aversion lead to difficulty in making swift decisions causing excessive test orders. High introversion also predicts excessive test ordering, perhaps related to a reluctance to gather information through conversation with the patient. The point is that while gender may be related to physician practice, the effect is narrow and should be focused on identifying the specific personality traits and practices that affect patient outcomes. Along these lines, pre-employment assessments can be designed to measure the relevant personality traits needed to hire people likely to deliver quality care and your intended patient care experience: whether in a hospital, outpatient, or long-term care facility. Assessment results can also enable coaching for new hires in areas that may impede performance.
In sum, we are just starting to learn how gender influences patient outcomes. The most valuable result of this research is identifying the personality traits, abilities, and behaviors that lead to improved patient outcomes and continuity of care. This can guide us in creating accurate hiring, training, and development systems that support performance and a connecting patient experience that fosters well-being.
Do you have more questions about how to understand and measure the qualities you need for performance – whether for physicians, nurses, or frontline staff? Learn more about how assessments can be used across positions to help provide a patient experience that builds continuity of care in our eBook: Hiring Assessments – The What, Why, and When.Resources