New research shows that when a health crisis hits, a doctor’s gender could influence a patient’s chances of survival. Under an administration with a blatantly dim view on civil-rights issues, looking at how gender works in our medical institutions will say a lot about how women will fare in the health-care system under Trump, whether they’re wearing a white coat or a hospital gown.
Researchers at the Harvard School of Public Health recently analyzed how both the nature of gender and the surrounding social patterns have real-life, quantifiable health impacts: Patients treated by women doctors fared better than those treated by their male counterparts.
Tracking older patients over a month-long period, researchers found that people “treated by female physicians had significantly lower mortality [and hospital readmission] rates.” Overall, they concluded, “Elderly hospitalized patients treated by female internists have lower mortality and readmissions compared with those cared for by male internists.” Even within the same hospital, across different ailments “ranging from arrhythmia to sepsis,” for Medicare beneficiaries and other older patients, the chances of surviving crisis or avoiding rehospitalization are improved if your doctor happens to be a woman. The estimated net effect of the doctor-gender gap is that “approximately 32,000 fewer patients would die if male physicians could achieve the same outcomes as female physicians every year.”
But paradoxically, among physicians, women are both underrepresented, and earn less than men. According to the accompanying editorial, published in JAMA Internal Medicine, yearly “salaries for female academic physicians are $19,879, or 8.0 percent, lower than those of their male colleagues.” So, altogether, women are paid less, but provide better care. The patterns reveal how job segregation and discriminatory pay gaps pose barriers even for elite professional women. (A planned strike on International Women’s Day is meant to address these disparities—but is it only for privileged women?)
Is the answer then to hire more female doctors and pay them more? Not quite; the root cause is less about Dr. Jill’s versus Dr. Jack’s bedside manner than about the social systems shaping their careers. Systemic gender bias buttresses the whole health-care infrastructure.
Though the findings are limited by the demographics and binary gender categorization, the study illustrates how gender divides systematically influence patient experiences. Among older patients, critical health issues turn on subtle differences in practice that are linked to gender identity.
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The researchers point to studies showing women doctors are more inclined to “practice evidence-based medicine…and provide more patient-centered care.”
In a way, this matches the stereotype that women are “natural” caregivers, but there is truth—whether from nature or nurture—to the idea that women tend to be more focused on the patient and interact more sensitively to patient needs. This could reflect “feminine” socialization, or gendered experiences throughout one’s education and developmental years. But it also reflects the realities of working in a health-care system that prioritizes commercialism, monetizes treatment and care, and measures “quality” in narrow statistical terms and insurance payments.
It’s true that feminism as a political concept has benefited the health-care field, and that gender-conscious standards, practices, and social policy are vital to strengthening public health. But to say “women do it better” is missing the point. It’s also missing the point to say that the answer is recruiting more women into medical school or automatically writing off the capacity of male doctors to be equally caring.
Indeed, the types of holistic care associated with truly better outcomes are, sadly, at odds with the current health-care system and the policies undergirding it. Gender divides reflect gender bias in every component of medicine, from training to sexist stereotypes among employers. For example, gender salary gaps reflect wide pay differences in specialties, such as surgery, that are dominated by men.
But pay discrimination persists even within the same field; women across different medical subfields generally earn less than their male colleagues. This may be because of the structure of work schedules, as women who are primary family caregivers may be constrained to lower-paying fields with steadier hours, like primary care.
While these structural biases persist, our health-care system profits off a corporatized health-care infrastructure—something that becomes even more acute when you look further down the labor hierarchy. According to Ariane Hegewisch, program director of employment and earning at the Institute for Women’s Policy Research (IWPR), “the undervaluation of women’s work in professional medicine is perhaps most clearly evident when we compare nurses and doctors…. Nurses earn well compared to many other female dominated professions, but not compared to doctors.”
Gaps in doctor compensation and in quality and access to care parallel trends in economic inequality and gender segregation in the workforce across the economy. IWPR’s research on poorer working women shows “workers in female-dominated, low-wage jobs” such as childcare and restaurant service, in which women do 80 percent of jobs, “make $11.30 per hour on average, while workers in all other low-wage jobs—one in three of whom are women—make $0.51 more per hour.”
Mirroring the trend of salary discrimination among disproportionately qualified women doctors, women in lower-paying sectors also tend to have higher education credentials than male peers—meaning that women aren’t just paid less for equal work but also paid even less for doing more and better work.
Soon both health equity and gender justice may see a regression, at least at the federal level under Trump and a Republican Congress. Tom Price, as head of Health and Human Services, threatens to drastically undermine programs supporting women’s health and reproductive health, including contraceptive access. Similarly, Trump is expected to shift the ideological bent and agenda of the Supreme Court and the Equal Employment Opportunity Commission, which could impact gender-equality issues in the workplace. On top of rightward shifts on civil rights, the Republicans’ planned budget cuts would undermine working women’s access to health care and potentially exacerbate gender wealth gaps in the health-care professions. The struggle may then fall to local and state governments and individual workplaces.
If Trump stymies political progress on gender equality in health care, women will have that much more of a stake in the coming policy battles over discrimination. For women doctors, their careers depend on it. For women patients, their bodies are on the line. If the White House doesn’t respect women, though, the institutions and clinicians doing care work can lead by example, as workers, caregivers, and community members.
