A Université de Montréal team, studying the quality of care provided to elderly diabetic patients by Quebec practitioners of family medicine, recently released a report on their findings. [NOTE: The link to the report points to the University of Montreal news page in English, detailing the study. However, the reference provided at the end points to a French-language abstract in a Conference book with scant data; therefore, for my comments, I am forced to rely mostly on the Université de Montréal communiqué in English.] The report brought out screaming headlines, “Female doctors are better than male doctors” (EurekAlert) and “Women Make Better Doctors Than Men” (Time Magazine). The sensationalized headline piqued my curiosity enough – by which I suppose the headlines did their job! – for me to take a gander at the report.
The overall objective of the study was to look for two parameters related to the physicians serving the Family Medicine Group (les groupes de médecine de famille, GMF) that Québec had established in 2002 to organize its healthcare delivery: (a) quality of care (as indicated by strict adherence to the practice guidelines of the Canadian Diabetes Association) and (b) the productivity (as measured from billing data; the number of procedures done – and charged for – per year). The specific group of physicians to be scrutinized was comprised of 906 doctors (431 women and 475 men; I don’t know why the English news report kept floating a vague estimate: “over 870 practitioners,” it said) who looked after elderly diabetic patients.
For diabetic patients 65 or older, the CDA recommendations are fairly straightforward: biennial ophthalmic exams, three prescriptions for appropriate medications, and annual medical exams. From the data pulled from the patient records kept under the auspices of Québec’s health-insurance administration (la Régie de l’assurance-maladie du Québec), the researchers found that, apparently, compared to the men physicians, more women physicians emphasized the eye-care visit (73% vs 70% by the men), provided smoking counseling (1.8% vs 1.4% by the men), prescribed the recommended medications (68-70% vs 64-66% by the men, for statins and other drugs), and insisted on the annual review (43% vs 31% by the men).
In contrast, the women physicians apparently charged for only 3100 procedures in a year versus 4920 by the men, and therefore, they were considered to be less productive than their male counterparts.
The abstract and the report both mention that these differences are “Statistically Significant”, although in absence of a clear significance criterion and a definition of variables, it is unclear to me how the Student’s Test (I assume, the t-test) – mentioned in the Methods section of the abstract – was used to compare the difference between these percentages.
I have no choice but to disregard the questions of study methodology (since those answers cannot be found in a Conference abstract). However, I heartily disagree with the way these research questions have been framed. Let me clarify.
I have a specific and abiding distrust of these men vs women narratives; in fact, I think they are deeply divisive and reprehensible, because they tend to enforce certain assumptions or memes about women being more caring than men. Régis Blais, Professor at the Department of Health Administration and co-supervisor of the study, even commented, “People assume that women doctors spend more time with their patients, but it is difficult to observe in a scientific study. This study does just that.” This may not be an incorrect observation per se, but formalizing that via a research question would, in turn, tend to bring in certain other memes about men (‘less caring’, ‘more aggressive’, et cetera, including the execrable ‘boys would be boys’). These memes are at best counter-productive, and at worst end up being eventually harmful for all concerned, in terms of engendering and enabling certain widely-prevalent anti-woman biases. Valérie Martel, the lead author, said, “[…] women temporarily leave the network to start a family. They work fewer hours to spend more time at home when they have children. Inevitably, this change has an effect on the management of resources […]” I don’t know how much of a problem this is in Canada as a whole (see Ontario Human Rights Commission statement) and Québec in particular, but in the US, pregnant workers are known to face workplace discrimination on a routine basis. This is why gender segregation, especially gender segregation in caregiving, is a nasty concept.
Anecdotally, if one looks at any hospital across the US, one may always find a certain subsection of patients who’d not prefer to be treated by African American, Jewish, or Latino physicians or caregivers. (More mind-bogglingly, sometimes hospitals do pander to these racist requests. For a more comprehensive treatment of this issue, see here.) Gender segregation is no less objectionable or disgraceful than racial or ethnic segregation in healthcare. If, in the above study, one substitutes gender with race/ethnicity and makes a cohort with such physicians, I can almost guarantee that one would come up with a similar sort of differential observation. Because of a priori separations, conclusions drawn about groups from such observations would be meaningless.
Note that I am not disregarding the observations of this study. The authors have already commented upon the need to redefine and expand the concept of ‘productivity’ in healthcare delivery in a way that takes into account the overall experience of the patient. In addition – in my opinion – what this sort of study should focus on – and the data are there if one reads between the lines – is how compliance to existing patient care guidelines improves the standard of care and the outcome for patients, regardless of whether women or men are doing it. Also, as an important corollary, these studies should try to discern why women doctors seem to be more compliant with the guidelines than the men doctors are, despite receiving the same or similar training. Divvying up patient care between men and women doesn’t serve at all the main purpose of this enterprise, the care of patients.
Roxane Borgès Da Silva, Valérie Martel, & Régis Blais (2013). Qualité et productivité dans les groupes de médecine de famille: qui sont les meilleurs? Les hommes ou les femmes? Revue d’Épidémiologie et de Santé Publique, 61 (Supplement 4) DOI: 10.1016/j.respe.2013.07.021