Finally, A Good Doctor! by Pat Conrad MD

“The study’s authors estimate ‘that approximately 32,000 fewer patients would die if male physicians could achieve the same outcomes as female physicians every year.’” Which if you think about it, means male physicians are saving taxpayers a lot of extra Medicare dollars. Which is a ridiculous thing to say, right?

So now we have a study that as much as declares that women are better doctors than men – after all, what could be a better benchmark than mortality? According to this study, “The patients had 4 percent lower odds of dying within a month after being admitted to the hospital and a 5 percent smaller chance of repeat hospitalizations within the first month after leaving the hospital.” Why did someone even think to study this? Isn’t trying to find a gender difference blatantly sexist? When do we run a study to see if minority, non-English-as-first-language doctors do better than the patriarchal traditionalists?

“There is evidence in the primary care setting suggesting that, compared with male physicians, female physicians are more likely to practice evidence-based medicine, perform as well or better on standardized examinations, and provide more patient-centered care.” Oh hell yeah, NOW we’re talking. A study of Medicare i.e. government patients run by a Harvard investigator damn sure better wave the “quality” flag, or else. And yet neither the study, nor the fawning editorials can actually define the basis for purported superior female performance.

“An editorial about the study urges doctors to remedy the gender disparities in care and the pay gap that favors male physicians over women.” Good, they got that obligatory check in the block.

“Still, the findings that female internists provide higher quality care should push hospitals to do a better job of promoting and paying women, who typically earn less and have fewer opportunities for advancement,” say Dr. Anna Parks and Dr. Rita Redberg of the University of California. “Some have suggested that home responsibilities might contribute to female physicians providing inferior care and thus justify these disparities…The data from this paper should serve to highlight these inequities – female physicians provide equivalent or potentially better care compared to male colleagues yet get promoted less often and have lower salaries than their male colleagues. We want to close that gap.”

There was no statistically significant difference in gender readmission rates for CHF, GI bleeds, and UTI’s; why was there a gender statistical difference for sepsis, pneumonia, renal failure, and arrhythmias?

I don’t know what, precisely, but something is nonsensical about this study and all the fashionable commentary attached to it. Every one of us has worked with some damn fine female physicians, some truly worthless male physicians, and vice versa. I have bitched about XY hospitalists not taking an admission just because it was a critical bounce-back, and I’ve complained the same about their lady counterparts. While I have not collated the data on a million Medicare patients, I know what I see every day, and it ain’t this.

“The study is observational and doesn’t explain why there might be better outcomes with female doctors, the researchers note. It’s possible that gender serves as a marker of differences in practice patterns that might influence outcomes.” Uh-huh. Does anyone think that a study showing better outcomes with male physicians would ever see the light of day?

Under “Limitations”, the authors note, “we could not capture respondents who were transgender … Any misclassification in self-reported sex would likely bias our estimates toward the null.” That about sums it up for me.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  8 comments for “Finally, A Good Doctor! by Pat Conrad MD

  1. Bridget Reidy
    December 28, 2016 at 10:47 pm

    Those of us sick of the way we are paid and wanting to point out that communicating with patients is important should use this study, not scoff at it. The doctors were compared at the same hospitals, so age might be a factor but not hospital. the study pointed out how small the difference was, but it happens to be in a situation where the better outcome should translate into better pay, and clearly it doesn’t, at least yet. I’m not for pay for performance but when my patients come out of the hospital and they and I have no idea what happened in there so we can’t prevent it happening again something’s gotta give. The authors point out that what we know about females on average is they spend more time or do better with communication and following guidelines. Further study should see if the true cause was one of these but I suspect it’s communication. Commentators here have me wondering if it’s age and more modern treatments but that would also be important for us old fogies to know, but it’s possible they controlled for age as they did for nearly everything else.
    The fact that some administrator is pocketing the PFP bonus and paying the doctors who earned it less should have us all concerned. The fact that we are paid for RVU’s or public health check boxing instead of what patients require, time and communication and their individual needs addressed, should concern us all. Any study that might lead the administrators to believe communication matters is a worthwhile study in my book. Clearly none of us talking about it anecdotally has had any impact.

  2. hawgguy
    December 26, 2016 at 12:00 pm

    You guys are evil. I am officially triggered and will be retreating to my safe space to cuddle my blanket and pee my pants.

  3. John Parkin M.D.
    December 26, 2016 at 10:14 am

    As I recall from past studies on gender income disparity that females tended to work fewer hours than male counterparts, not because of institutional discrimination. Maybe fewer hours makes one better prepared to take care of patients ?

  4. December 26, 2016 at 8:54 am

    Another aspect of this article’s general commentary is that they point to the male to female physician pay differential and strongly imply sexism as the cause. However, of all industries this would be least likely in medicine. Most physicians are reimbursed based on a gender blind RVU system. Now, I personally do not like the RVU system because I feel we do not need a medical system specific economic unit of value to value services when one already exists and is used in the rest of the economy (money). But, for the doctors who are paid this way RVU calculations are gender blind. Thus, any pay differentials would have to be attributed to other causes.

    • Doug Farrago
      December 26, 2016 at 10:54 am

      Exactly!!!

  5. Steve O'
    December 26, 2016 at 8:45 am

    When a position declines in status and pay, higher-ups seek a way to cash in on the “pink discount.” It’s why the gender disparity has not changed after at least 50 years of looking at it. It remains because it is a useful wedge between workers.
    I have not seen if the age disparity is shown The average age of male physicians is 50, and the female physicians 30, when last I checked. Younger people, having known less history of the system, are more likely to accept the foolishness of the present than the older physicians.
    One can be sure of this – that the researchers are not noticing this for the purposes of increasing the expenditure of time, facilities and money upon physicians in general! Women just produce a more satisfying workproduct to the leaders; let’s keep the discount, and pass on the savings to YOU, customer!

  6. Thomas D Guastavino
    December 26, 2016 at 8:18 am

    The study also said the female doctors saw fewer patients and more likely to be working in a teaching hospital. I would bet that any physician seeing fewer patients and having an army of residents to back them up would have better results.

  7. HJR
    December 26, 2016 at 7:25 am

    Careful. Someone might label DPC as an “Alt-right” medical movement. Although, I thought gender was a social construct anyway.

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