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DESPITE a big growth in the number of female GPs in the past 20 years, differences between the types of conditions male and female GPs manage have remained consistent, according to new research in the MJA.
The study, using Bettering the Evaluation and Care of Health (BEACH) data, also found female GPs are more likely than their male counterparts to refer patients on, order imaging and pathology, and manage psychological or social conditions. (1)
It showed that, while the proportion of female GPs had almost doubled (to about 40%) in 20 years, the proportion of female GP consults involving female patients remained steady, at around 70%.
“This is surprising, since we had hypothesised that as female GPs increased their share of the GP workforce (and workload) they would see proportionally more male patients”, the researchers wrote.
Female GPs, who were generally younger and less experienced, were more likely to manage psychosocial, female or “unspecified” matters. Female GPs also recorded significantly more reasons for each patient encounter than their male counterparts.
Dr Nola Maxfield, a GP in Wonthaggi, Victoria, and former president of the Rural Doctors Association of Australia, said the research showed that female GPs were managing more complex conditions. Dr Maxfield said this was probably because women who usually saw a male doctor would present to a female doctor when they had female-specific problems as well as with their regular problems.
“The male GPs get to do the easier stuff and the female doctors have increased reasons for each encounter”, she said.
As female patients were also more likely to take emotional responsibility for their whole family, this could explain the higher prevalence of psychosocial problems being managed by female GPs, Dr Maxfield said.
Dr Steve Hambleton, a GP and president of the AMA, said some of his female colleagues echoed the findings in the paper, claiming to have more patients who would present for a consultation, and burst straight into tears.
But his own consults were also mostly complex cases. “I wish I could be one of those GPs with all the quick cases”, he said.
Health economist Professor Anthony Scott, head of health economics research at the Melbourne Institute, University of Melbourne, agreed the research could suggest that female GPs were managing more complex conditions.
Professor Scott leads the MABEL (Medicine in Australia — Balancing Employment and Life) study, which found that female GPs earn less than males, even after accounting for various confounders including length of consultation. (2)
“If they are treating more complex conditions and being paid less, then it is a particular issue”, he said.
Women in the BEACH study used higher rates of clinical treatments such as advice and counselling, and wrote fewer prescriptions. The researchers said this suggested that females provided more preventive care.
Dr Maxfield said that payment models should value this female style of practice more highly.
“Unfortunately the MBS [Medicare Benefits Schedule] rewards procedures more highly than people’s time and clinical expertise”, she said.
Commenting on the finding that women also referred more and ordered more imaging and pathology, Professor Scott said this could be because women were managing complex cases, or because they were more likely to work part-time and thus had less accumulated expertise.
Each year the BEACH study asks about 1000 GPs to provide information on 100 consecutive patient encounters. Dr Hambleton cautioned that although the data was useful, it was difficult to draw conclusions due to possible confounding variables or recording bias by the participating GPs.
“If you’re very busy in your practice you may record fewer things”.
– Sophie McNamara
2. Medicine in Australia: Balancing Employment and Life. The Australian longitudinal survey of doctors
Posted 15 August 2011
While I can understand that space is limited in reporting these studies, I cannot understand how the conclusions stated are derived from the data presented. How do we go from the data presented straight to female GPs see more complex cases and should be remunerated appropriately? More counselling and fewer prescriptions suggested an emphasis on preventative care? How is this a logical progression? I thought that the medical profession was pretty conservative about making proclamations of hypotheses as given fact, especially if potential bias is present. I am not disputing that all of the above may be accurate, but perhaps the altered case load is due to natural empathy and communication skills of the female GPs, or lack of it in male GPs? Or any number of other potential hypotheses?
I cannot work out the increased imaging (unless it is down to U/S Pelvis for menstural problems and breast imaging for breast problems), but increased pathology could easily be related to the increased number of “non-specific” illness presentations, these almost always involve routine blood exams to exclude basic pathology. In addition, the majority of smears are often undertaken by the female partners in a practice and so increases the rate of pathology and if you add Chlamydia screening to a proportion of those smears, the pathology count is stacking up.
The concern is that if we female GPs are not seeing the men, they are either not attending or our male colleagues are picking up more and more consults