Female Gastroenterologists Linked to Lower Healthcare Use Post-Consultation

Laura Targownik, MD

Credit: University of Toronto

Initial consultations with a female gastroenterologist led to a significant reduction in subsequent health care utilization, compared with consultations by a male gastroenterologist, according to new data presented at Digestive Disease Week (DDW) 2024.¹

These patients were less likely to use medical care in the emergency department (ED), hospital, or primary care for two years after their visits—hypothesized causes ranged from female gastroenterologists providing more comprehensive care to the funneling of more complex patients to male physicians.

“If there really is something different about the way female and male gastroenterologists provide care that impacts patient outcomes, it will be important to share these learnings broadly among health care providers to improve the standard of care for all patients,” lead author Laura Targownik, MD, a clinician-investigator at Mount Sinai Hospital and department division director of gastroenterology and hepatology at the University of Toronto, said in a statement.²

Female physicians make up only one-third of all gastroenterologists, despite women being more likely to seek gastrointestinal care and experience a great prevalence of function GI disease.³ Receiving care from a female physician has been known to improve surgical outcomes and lead to higher satisfaction for care, with gender-based concordance as a relevant quality indicator.

Targownik and colleagues noted, however, that no studies have examined the impact of a gastroenterologist’s gender on the management of patients who seek GI care and their subsequent course of care.¹ Using the Ontario Health IC/ES population-wide database, the team examined all individuals who received an outpatient luminal GI consultation between 2002 and 2020.

The subsequent use of direct health care services was cataloged over the following two years, focusing on primary care visits, ED visits, and inpatient hospitalizations. Incidence rates for all healthcare utilization methods were calculated and categorized by patient and physician gender. Incident rate ratios were then calculated and stratified by gender.

During the study period, more than 2.7 million gastroenterology consultations were identified, of which 1,499,819 (55.1%) were performed for female patients. However, female gastroenterologists performed only 15% of all consultations.

In the subsequent two years after GI consultation, female patients exhibited a higher rate of ED visits (odds ratio [OR], 1.13; 95% CI, 1.13 - 1.13) and primary care visits (OR, 1.21; 95% CI, 1.21 - 1.21) than male patients, with a lower rate of inpatient hospitalization (OR, 0.89; 95% CI, 0.89 - 0.90).

However, when female gastroenterologists provided the initial consultation, the subsequent use of all health care services, regardless of gender, was lower for all patients, compared with patients initially seen by a male gastroenterologist. This was noted for ED visits (OR, 0.88; 95% CI, 0.88 - 0.89), primary care visits (OR, 0.93; 95% CI, 0.93 - 0.93), and inpatient hospitalizations (OR, 0.80; 95% CI, 0.80 - 0.81).

In particular, the reduction in healthcare utilization lowering effect after the initial consult with a female gastroenterologist was more significant for female patients than male patients. As a result, investigators urged the need for more research to determine better the reason for the meaningful difference in patient outcomes based on the gender of gastroenterologists.

“The next step is to take a closer look at the patient data — including preexisting conditions, the health care utilization patterns prior to an initial GI consultation, and the diagnoses that occur during that consultation – in order to investigate whether there are other factors driving patient’s health care-seeking behavior,” Grace Wang, a gastroenterology resident at the University of Toronto, added in a statement.²

References

1. _{Herblum J, Wang G, Benchimol EI, Baxter NN, Alta A, Boblitz A, Targownik LE. THE IMPACT OF PHYSICIAN GENDER ON HEALTH CARE UTILIZATION AMONG MEN AND WOMEN FOLLOWING INITIAL GI CONSULTATION. Poster presented at Digestive Disease Week 2024, May 18 - 21, 2024.}
2. _{Press Release}
3. _{Starkey M, Daboul J, Lang J, Hart B, Ekwenna O. Trends in female representation in gastroenterology fellowships in the United States. Ann Gastroenterol. 2022;35(6):577-583. doi:10.20524/aog.2022.0747}