Intended for healthcare professionals


Effects of gender on performance in medicine

BMJ 2008; 336 doi: (Published 03 April 2008) Cite this as: BMJ 2008;336:731
  1. Jenny Firth-Cozens, professor
  1. 1London Deanery, London WC1B 5DN
  1. jfirth-cozens{at}

Men may have higher output than women, but this is possibly offset by litigation and disciplinary action

A recent study assessed the workloads of 7236 male consultants and 1048 female consultants in the 10 most common specialties using data from the hospital episode statistics for England 2004-5.1 It found that, on average, male consultants completed 160 more episodes of care each year than their female colleagues. More women graduate from medicine than men, and the authors suggest that their finding could have financial implications beyond those of maternity leave. The authors point out possible flaws in the study, however, such as the accuracy and validity of the underlying hospital data. For example, if consultants work in teams, coders might allocate work to the most senior consultant in the team, who is more likely to be a man. Also, activities were limited to inpatient and outpatient settings, so other activities such as teaching and administration would have been ignored. More importantly, the findings may reflect the way that women doctors work—perhaps they spend longer with their patients than their male colleagues and communicate differently.

Differences exist in the way that men and women work, both in medicine and other professions.2 One meta-analysis has shown that women have longer consultations, are more patient centred, engage in more emotionally focused talk, counsel more psychosocially, and that their patients speak more.3 Consequently, female consultants overall must conduct fewer patient episodes, unless they also work longer hours.

Rather than seeing the implications of this only in terms of cost to health services, economists and accountants must weigh this finding against the costs that arise from male doctors consistently experiencing more litigation and discipline than female doctors. For example, a recent report by the National Clinical Assessment Service (which assesses and makes recommendations for doctors and dentists in difficulties) found that significantly more male doctors were referred to the service than female ones.4 Although women accounted for 42% of the general practitioner medical workforce and 37% of the medical hospital and community workforce in 2004, only 13% of general practitioners and 20% of hospital and community doctors referred to the National Clinical Assessment Service were female. These differences were not explained by an age cohort effect or by grade, and women were under-represented proportionally in all hospital and community specialties. For example, only 9% of surgical referrals were women, even though they form 20% of the surgical workforce.

The sex difference regarding disciplinary action is similar around the world. For instance, after controlling for all demographic factors, male doctors in the United States were three times more likely than women to have claims for malpractice made against them.5 In England only six of the 49 career doctors with problems reported by Donaldson were women.6 Although 31% of general practitioners in Norway are women, only 15% were referred to the Norwegian Board of Health.7 Similarly, only a small proportion of doctors with alcohol problems are women,8 and virtually none has been referred for sexual misconduct or fraud.9

Such findings do not suggest that male doctors as a group are inferior to female colleagues in terms of performance, but that the less favourable tail of the normal distribution curve is populated more by men, as it is in many other areas of life such as addiction, delinquency, and risky behaviour. For example, egoism, which relates to deviance in general, is lower in women,10 whereas impulsivity is greater in men.11 At a less extreme level, women’s superior communication skills3 and greater emotional intelligence12 may help them forge better relationships with patients and so make them less likely to be the subject of complaints, claims, or discipline.

Although the implications of the proportional rise of female doctors must be taken into account, it would be an error to tackle this simplistically. Several other differences between men and women may need to be considered, but undoubtedly any financial estimation that compares the costs of employing male or female doctors must also take into account sex differences in the costs of poor performance, litigation, re-education, and rehabilitation.



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