Female physicians have better patient outcomes compared with their male peers, while female patients are less likely to receive guideline-recommended care when treated by a male physician, according to a systematic review from ACC’s Cardiovascular Disease in Women Committee published Feb. 22 in the Journal of the American College of Cardiology.

Emily S. Lau, MD, et al., looked at 13 studies examining the patient-physician gender relationship across multiple specialties and its role in the care patients receive. Of these, eight studies examined patient outcomes based on physician gender.

In one study, investigators found that female diabetes patients were less likely to receive intense treatment than male patients, particularly when treated by a male primary care provider. In another study, mortality rates for myocardial infarction patients were highest among female patients treated by male physicians. If the treating physician was female, mortality rates remained the same between male and female patients. The authors also found that male physicians who had more exposure to female patients and physicians had more success in treating female patients.

The authors conclude that while care disparities can be attributed to multiple factors, they may relate, in part, to the differences in how cardiovascular disease presents in women vs. men, the underrepresentation of female subjects in clinical trials and the lack of women’s health training in U.S. medical education.

“We must continue encouraging young physicians from diverse backgrounds to enter the field of cardiology in order for our physician workforce to more accurately reflect the gender composition of our overall patient population,” said Malissa J. Wood, MD, FACC, incoming chair-elect of the ACC Board of Governors and the senior author of the study. “It is imperative that we ensure that all physicians provide the same level of high-quality care for all patients, regardless of gender. We need to incorporate comprehensive patient-centered communication and care into medical education.”

To combat these findings, the study authors proposed three major recommendations:

1. Increasing Gender Diversity in the Physician Workforce
   • Create interventions designed to address existing implicit and explicit biases which have limited opportunities for women in cardiovascular medicine.
   • Change the culture of cardiology to be more female- and family-friendly.
   • Increase representation of women in leadership positions in cardiovascular medicine.
2. Improving Gender- and Sex-Specific Medical Training
   • Focus curricula on the presentation, diagnosis and treatment of women and men, and highlight specific differences.
   • Include comprehensive behavioral health curriculum to address stress, depression and anxiety faced by women, as well as men, with cardiovascular disease.
   • Teach patient-centered communication styles.
   • Introduce implicit bias training.
3. Increase Research on the Role of Gender in Patient-Physician Relationships
   • Focus on nonrandomized experimental designs that incorporate economic approaches with medical research.

“A better understanding of the mechanisms driving gender differences in patient outcomes, including whether patient-physician gender concordance truly impacts patient outcomes, can help guide targets for interventions. More research is needed to understand the physician behaviors associated with improved patient outcomes, specifically in driving differential outcomes in gender patient-physician pairings, including drivers of implicit and explicit bias,” Wood said.

The ACC is committed to improving diversity and inclusion within the cardiovascular workforce and the College’s leadership and membership, and recognizes the success of its mission is dependent on including people who provide a diversity of backgrounds, experiences, ideas and perspectives. Learn more at ACC.org/Diversity.

Keywords: Diabetes Mellitus, Education, Medical, Myocardial Infarction, Patient-Centered Care

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