Does It Matter if Your Surgeon Is a Man or a Woman?

For Women, It Might Make a Significant Difference

Surgery is scary. There are so many things to consider prior to going into the operating room: is the operation absolutely necessary, if you are healthy enough to have surgery, the reputation of the hospital where the surgery will be performed, how you will pay for it, and where you will recover. You also want to know about your surgeon’s skill level. How long has he/she been practicing, how many times has he/she performed the procedure, and how will you get ahold of him/her if there is a problem after surgery?

But one question you may not have considered is this: does the outcome of your surgery matter if your surgeon is a man or a woman? A recent study indicates that, overall, female surgeons may actually have better results compared to male surgeons, and that, if you are a woman, choosing a female surgeon may be particularly beneficial for you.

The Study

The study, which was published in JAMA Surgery, was conducted in Ontario, Canada, by a team of international scientists who studied the records of 559,903 men and 760,205 women who had been operated on by 2,937 surgeons in that city over a 12-year period. Among the male patients, roughly 91% had male surgeons and 9% had female surgeons. Among the female patients, 88% had male surgeons and 12% had female surgeons. It covered a total of 21 common elective and emergency surgeries like appendectomies, vascular, and spinal surgeries, and other procedures such as cardiac surgeries including coronary artery bypass grafting (CABG), gastric bypass, neurological, plastic, thyroid, and orthopedic surgeries like hip and knee replacements.

Control Factors

The researchers controlled for factors such as income, age, whether the patient lived in a rural or urban area and if the surgery was done at a community hospital or a large academic medical center. They also took into consideration that the female surgeons were (for the most part) younger, did not recommend surgery as often as their male counterparts and, when they did perform surgery, they did so on patients who were usually healthier than those that the male surgeons operated on. What the researchers could not control for was the role and education level of the nurses and other hospital staff, and it did not include robotic surgeries, which were not done frequently in Ontario at the time.

Study Results

The study revealed that of the 15% of the patients who had postoperative complications, 8.7% of them had significant issues within 30 days; 6.7% of them were readmitted to the hospital and 1.7% of them died. When the sex of the surgeon was different from the patient, there was an 8% increase in postoperative complications and death. However, there was no difference when it came to readmissions to the hospital regardless of what type of surgery was performed or the type of patient it was performed on (old, young, healthy, etc.).

The researchers found that the patients of female surgeons tended to have better outcomes than the patients of male surgeons. And the patients who had the worst surgical outcomes were female patients who had male surgeons. When compared side by side, a woman treated by a male surgeon was about 15% more likely to have complications, to be readmitted to the hospital, or to die within 30 days after surgery as compared to a female treated by a female surgeon.

Reasons for the Difference

“There is no reason to think the female surgeons in the study were more technically skilled than the male surgeons,” said the lead author, Dr. Christoper J.D. Wallis, who is an assistant professor of urology at the University of Toronto. The differences in the outcomes of those patients may lie in the overall different communication styles of men and women and the way physicians communicate with male and female patients.

Approachability

From my own experience as an RN interacting with surgeons and observing surgeons interact with patients, it appears to me that patients feel female surgeons are more approachable compared to male surgeons. This allows them to disclose information that might be crucial when the surgeon is deciding whether or not he or she will take the patient to surgery in the first place. I think that this may be one reason female surgeons took fewer patients to surgery in the study. This approachability and welcoming atmosphere also make the patient and their caregivers feel like they can ask more questions, which can be important to their recovery as well.

Time

While all doctors rely on their nurses to give their patients information, female surgeons tend to spend more time explaining things to patients. They also do not appear to be as rushed, even though we know that they are just as busy as male surgeons.

Clear and Thorough Explanations

Female surgeons may also communicate before surgery more clearly and thoroughly what the patient should expect throughout the entire process. That can lead to a smoother recovery and fewer chances for the patient to engage in activities that they are not ready for. Female surgeons also tend to be sure that they give their explanations in terms that patients can easily digest. I think this is because women are used to explaining things to children more frequently than men. Therefore, this communication style spills over into their professional duties.

Welcoming Atmosphere

It’s not only communication between the surgeon and the patient that matters. In the operating room, the atmosphere tends to be different if the surgeon is a man or if it is a woman. Female surgeons often set a more collegial atmosphere, which creates an opportunity for learning and fosters teamwork. Associate professor of anesthesiology at the University of Toronto, Dr. Angela Jerath, “Female surgeons ask me more questions,” she said. “Maybe women are more collaborative. Maybe they are more detail-oriented. Maybe they are more meticulous. We can’t answer these questions with our data.”

Postoperative Responses

Postoperatively, doctors may treat patients differently. Some physicians may treat a complaint of pain coming from a man differently if it comes from a woman. While some pain is expected after surgery, sometimes a woman’s pain is not given as much weight as a man’s. So, when a woman complains of 8/10 postoperative pain on day four after surgery, it might be deemed as exaggerated. Female surgeons may realize that the patient is not exaggerating but rather exhibiting a symptom of a true emergent issue and will act sooner.

It’s Not Just Surgeons

It’s not only the surgical arena where the sex of the physician and patient can affect the outcome. Another study in 2018 revealed that the mortality rate was higher in females who had heart attacks if their physician was a male. There is evidence from other studies that demonstrate that in various specialties, higher death rates occur when male doctors treat female patients.

Conclusion

The results of this study bring up an interesting issue for women. It was a good sized study, and they tempered it for many issues that could have skewed the results. As a healthcare professional, would I recommend you choose your surgeon based on their sex alone? Definitely not. However, if you are a woman who needs surgery and are deciding on a surgeon or other specialist, I recommend you take the results of this study, and others like it, into consideration. There are thousands of terrific surgeons out there who are skilled, experienced, empathetic, and will do a fabulous job getting you through your surgery. And male doctors can also be approachable, not appear to be rushed, give patients thorough and understandable explanations of the surgical process, take a woman’s report of pain seriously, and respond quickly to postoperative complications. In the end, when the wounds have healed, what’s important is your relationship with, and trust in, your doctor.

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