The association between physician sex and patient outcomes: a systematic review and meta-analysis
Abstract Background Some prior studies have found that patients treated by female physicians may experience better outcomes, as well as lower healthcare costs than those treated by male physicians. Physician–patient sex concordance may also contribute to better patient outcomes. However, other studi...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12913-025-12247-1 |
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| author | Kiyan Heybati Ashton Chang Hodan Mohamud Raj Satkunasivam Natalie Coburn Arghavan Salles Yusuke Tsugawa Ryo Ikesu Natsumi Saka Allan S. Detsky Dennis T. Ko Heather Ross Mamas A. Mamas Angela Jerath Christopher J. D. Wallis |
| author_facet | Kiyan Heybati Ashton Chang Hodan Mohamud Raj Satkunasivam Natalie Coburn Arghavan Salles Yusuke Tsugawa Ryo Ikesu Natsumi Saka Allan S. Detsky Dennis T. Ko Heather Ross Mamas A. Mamas Angela Jerath Christopher J. D. Wallis |
| author_sort | Kiyan Heybati |
| collection | DOAJ |
| description | Abstract Background Some prior studies have found that patients treated by female physicians may experience better outcomes, as well as lower healthcare costs than those treated by male physicians. Physician–patient sex concordance may also contribute to better patient outcomes. However, other studies have not identified a significant difference. There is a paucity of pooled evidence examining the association of physician sex with clinical outcomes. Methods This random-effects meta-analysis was conducted according to the PRISMA guidelines and prospectively registered on PROSPERO. MEDLINE and EMBASE were searched from inception to October 4th, 2023, and supplemented by a hand-search of relevant studies. Observational studies enrolling adults (≥ 18 years of age) and assessing the effect of physician sex across surgical and medical specialties were included. The risk of bias was assessed using ROBINS-I. A priori subgroup analysis was conducted based on patient type (surgical versus medical). All-cause mortality was the primary outcome. Secondary outcomes included complications, hospital readmission, and length of stay. Results Across 35 (n = 13,404,840) observational studies, 20 (n = 8,915,504) assessed the effect of surgeon sex while the remaining 15 (n = 4,489,336) focused on physician sex in medical/anesthesia care. Fifteen studies were rated as having a moderate risk of bias, with 15 as severe, and 5 as critical. Mortality was significantly lower among patients of female versus male physicians (OR 0.95; 95% CI: 0.93 to 0.97; PQ = 0.13; I2 = 26%), which remained consistent among surgeon and non-surgeon physicians (Pinteraction = 0.60). No significant evidence of publication bias was detected (PEgger = 0.08). There was significantly lower hospital readmission among patients receiving medical/anesthesia care from female physicians (OR 0.97; 95% CI: 0.96 to 0.98). In a qualitative synthesis of 9 studies (n = 7,163,775), patient-physician sex concordance was typically associated with better outcomes, especially among female patients of female physicians. Conclusions Patients treated by female physicians experienced significantly lower odds of mortality, along with fewer hospital readmissions, versus those with male physicians. Further work is necessary to examine these effects in other care contexts across different countries and understand underlying mechanisms and long-term outcomes to optimize health outcomes for all patients. Review registration PROSPERO – CRD42023463577. |
| format | Article |
| id | doaj-art-0873ed50b9d849b3bfdc014e384cd647 |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Health Services Research |
| spelling | doaj-art-0873ed50b9d849b3bfdc014e384cd6472025-01-19T12:15:15ZengBMCBMC Health Services Research1472-69632025-01-0125111310.1186/s12913-025-12247-1The association between physician sex and patient outcomes: a systematic review and meta-analysisKiyan Heybati0Ashton Chang1Hodan Mohamud2Raj Satkunasivam3Natalie Coburn4Arghavan Salles5Yusuke Tsugawa6Ryo Ikesu7Natsumi Saka8Allan S. Detsky9Dennis T. Ko10Heather Ross11Mamas A. Mamas12Angela Jerath13Christopher J. D. Wallis14Mayo Clinic Alix School of Medicine, Mayo ClinicDepartment of Anesthesia, Sunnybrook Health Sciences CenterTemerty Faculty of Medicine, University of TorontoDepartment of Urology, Houston Methodist HospitalDepartment of Surgery, Sunnybrook Health Sciences CenterDepartment of Medicine, Stanford University School of MedicineDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLADepartment of Epidemiology, UCLA Fielding School of Public HealthDepartment of Orthopedics, Teikyo University School of MedicineDepartment of Medicine, Mount Sinai Hospital and University Health NetworkInstitute for Health Policy, Management and Evaluation, University of TorontoDivision of Cardiology, Peter Munk Cardiac Centre, University Health NetworkKeele Cardiovascular Research Group, Keele UniversityDepartment of Anesthesia, Sunnybrook Health Sciences CenterDivision of Urology, Department of Surgery, University of TorontoAbstract Background Some prior studies have found that patients treated by female physicians may experience better outcomes, as well as lower healthcare costs than those treated by male physicians. Physician–patient sex concordance may also contribute to better patient outcomes. However, other studies have not identified a significant difference. There is a paucity of pooled evidence examining the association of physician sex with clinical outcomes. Methods This random-effects meta-analysis was conducted according to the PRISMA guidelines and prospectively registered on PROSPERO. MEDLINE and EMBASE were searched from inception to October 4th, 2023, and supplemented by a hand-search of relevant studies. Observational studies enrolling adults (≥ 18 years of age) and assessing the effect of physician sex across surgical and medical specialties were included. The risk of bias was assessed using ROBINS-I. A priori subgroup analysis was conducted based on patient type (surgical versus medical). All-cause mortality was the primary outcome. Secondary outcomes included complications, hospital readmission, and length of stay. Results Across 35 (n = 13,404,840) observational studies, 20 (n = 8,915,504) assessed the effect of surgeon sex while the remaining 15 (n = 4,489,336) focused on physician sex in medical/anesthesia care. Fifteen studies were rated as having a moderate risk of bias, with 15 as severe, and 5 as critical. Mortality was significantly lower among patients of female versus male physicians (OR 0.95; 95% CI: 0.93 to 0.97; PQ = 0.13; I2 = 26%), which remained consistent among surgeon and non-surgeon physicians (Pinteraction = 0.60). No significant evidence of publication bias was detected (PEgger = 0.08). There was significantly lower hospital readmission among patients receiving medical/anesthesia care from female physicians (OR 0.97; 95% CI: 0.96 to 0.98). In a qualitative synthesis of 9 studies (n = 7,163,775), patient-physician sex concordance was typically associated with better outcomes, especially among female patients of female physicians. Conclusions Patients treated by female physicians experienced significantly lower odds of mortality, along with fewer hospital readmissions, versus those with male physicians. Further work is necessary to examine these effects in other care contexts across different countries and understand underlying mechanisms and long-term outcomes to optimize health outcomes for all patients. Review registration PROSPERO – CRD42023463577.https://doi.org/10.1186/s12913-025-12247-1DiversityEquityPatient outcomesPhysician sexMeta-analysis |
| spellingShingle | Kiyan Heybati Ashton Chang Hodan Mohamud Raj Satkunasivam Natalie Coburn Arghavan Salles Yusuke Tsugawa Ryo Ikesu Natsumi Saka Allan S. Detsky Dennis T. Ko Heather Ross Mamas A. Mamas Angela Jerath Christopher J. D. Wallis The association between physician sex and patient outcomes: a systematic review and meta-analysis BMC Health Services Research Diversity Equity Patient outcomes Physician sex Meta-analysis |
| title | The association between physician sex and patient outcomes: a systematic review and meta-analysis |
| title_full | The association between physician sex and patient outcomes: a systematic review and meta-analysis |
| title_fullStr | The association between physician sex and patient outcomes: a systematic review and meta-analysis |
| title_full_unstemmed | The association between physician sex and patient outcomes: a systematic review and meta-analysis |
| title_short | The association between physician sex and patient outcomes: a systematic review and meta-analysis |
| title_sort | association between physician sex and patient outcomes a systematic review and meta analysis |
| topic | Diversity Equity Patient outcomes Physician sex Meta-analysis |
| url | https://doi.org/10.1186/s12913-025-12247-1 |
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