When you choose a surgeon, a number of factors might cross your mind: Can I afford their services? How quickly can I see them? Did someone I trust refer me to them? What is their reputation?
But medical researchers looking at health disparities have become increasingly interested in another question — one that could have major implications for the quality of your care: Does your doctor’s gender matter? And if so, how much?
A study published in the medical journal JAMA Surgery found that both male and female patients experienced better health outcomes with women surgeons. But the difference between having a male or female surgeon was more pronounced for women patients, who experienced notably lower incidences of complications, readmissions and death after being operated on by a woman.
Researchers say the recent study doesn’t just highlight the real-world medical consequences of a lack of practicing women surgeons — as of 2019, women made up just 22 percent of all general surgeons, according to the Association of American Colleges, and they were even less represented among specialized surgery, like orthopedic and neurological surgery.
The gender differences they found suggest differences in practice that are worth exploring to improve health outcomes for all patients, researchers said.
“We need to find out what it is about female surgeons and what they’re doing,” said Angela Jerath, a clinical epidemiologist and associate professor at the University of Toronto who co-authored the study. “That is something we can all learn from.”
A 2017 study found that patients of women surgeons have lower death rates, fewer health complications and lower rates of readmission than those of male surgeons. But Jerath and lead study author Christopher Wallis, a urological oncologist and assistant professor at the University of Toronto, wanted to see whether there were differences among male and female patients.
Wallis, who was also a co-author of the 2017 paper, said he was curious if gender divides that came up in other comparative studies, such as one that looked at heart attacks, could apply to surgery. Could differences in outcomes between male and female surgeons be linked to the genders of their patients?
To answer that question, they combed through records of more than 1.3 million patients in Ontario who underwent 21 common surgical procedures between 2007 and 2019. The surgeries, performed by 2,937 surgeons, included weight loss surgery and hip and knee replacements, as well as more complex procedures, such as heart bypasses and brain surgeries.
Researchers chose to focus on outcomes of care post-surgery: complications within a month of the operation, readmission and death — the sort of data that would be “meaningful to patients,” Wallis said. What they found was that both men and women experienced less adverse outcomes with women surgeons than they did with surgeons who were men.
But the difference for male patients was slight compared to women, who were 15 percent more likely to experience adverse effects with male surgeons than they were with women.
Overall, the data showed women whose operations were performed by a male surgeon had a 32 percent higher risk of death post-surgery than those who were operated on by a woman.
Female patients also experienced longer hospital stays, had a 16 percent greater risk of complications and an 11 percent higher risk of readmission when operated on by a male surgeon, the study found.
While the differences are notable, the results “should not prompt immediate panic,” cautioned Wallis, who noted that the overall rate of adverse outcomes remains low. For example, the likelihood of a female patient dying after undergoing brain or vascular surgery was about 0.9 percent with a female surgeon; that likelihood was still very low — just 1.2 percent — when she was operated on by a man.
Wallis, who has studied gender differences among doctors before, expected to see some disparities, but said he was taken aback by the size of the gap. Jerath said she was even more surprised than her colleague.
“We certainly had quite a few conversations before this paper was written up,” Jerath said. She and Wallis frequently discussed methodology and models to ensure that their findings were sound, she added. Even when they controlled for other factors — including patient age, chronic health status, surgeon experience and specialty, and the type of hospital the surgery was performed in — the gap persisted.
The findings “should definitely prompt us to be thoughtful and consider how we can do more research and evolve our practices in order to limit the gap,” Wallis said.
The Royal College of Surgeons of England told the Guardian that the findings were “interesting. Much more detailed research is required looking at communication, trust and doctor-patient relationships.”
Both Wallis and Jerath said they agree that the differences in outcomes aren’t “technical” — surgeons of all genders receive the same training and expertise. Rather, they suspect that how women surgeons practice could possibly produce better outcomes.
Jerath speculated that women surgeons may counsel their patients differently, consult with other specialists more frequently and communicate with patients more post-operation. These are the kinds of processes that can define a physician’s practice, but are not formally taught in med schools, she said.
Wallis said it is possible that women surgeons may be more attentive to complication symptoms — particularly among their female patients — than their male peers. But he also pointed to the relatively low percentage of women surgeons, especially in specialized roles.
“The culture of medicine and surgery makes it harder for women to gain entry than men,” Wallis said. “If women have a higher barriers to entry, then only those who are truly exceptional will get in.”
Over the years, researchers have speculated on the existence of a “surgical personality”: traits considered more endemic to surgeons than other physicians, such as extroversion or neuroticism. But this perception has also been gendered, researchers note: One 2006 survey found that 22 percent of women considering careers in surgery said they were deterred by what they saw as “an old boys’ club.” Women who become surgeons also experience discrimination, sexual harassment and false assumptions about their abilities, according to the AAMC.
Wallis said the recent report, combined with other literature, emphasizes the importance of making surgery a more welcoming field for women.
“Diversifying the health-care workforce and the surgical workforce is undoubtedly going to lead to better outcomes,” he said. “Not just because, potentially, this diverse workforce better identifies with our patients in the community, but also because there’s a diversity of ideas.”
Jerath noted that their research can’t be used to make decisions about specific doctors: “Population-level data is not going to reflect an individual surgeon’s practice.”
“What the data does show,” Jerath said, “is that there’s some kind of signal here, that we’re picking up in a huge data set, that can’t really be ignored.”
The larger goal is to conduct more research to illuminate these differences, which could then lead to educational interventions that improve outcomes for all patients, Wallis added.
Personally, he said, the data has led him to be more introspective.
“I really spent some time thinking about how it is I may interact different with male and female patients,” he said. “Maybe I’m not interacting differently, and that’s the problem.”