Female doctors request more diagnostic tests in emergency departments

A new UCLA Health study examining more than 1.5 million emergency department (ED) visits found that female physicians request more imaging and laboratory tests and admit more patients to the hospital than their male counterparts working alongside them. But the added testing was just as likely to uncover important findings, suggesting the additional care may have been clinically appropriate. 

Our research finds that in the emergency department setting, female and male physicians may approach diagnostic uncertainty differently, and these differences don't necessarily represent unnecessary care."

Dan Ly, assistant professor of medicine, division of general internal medicine and health services research, David Geffen School of Medicine at UCLA and the VA Greater Los Angeles

Researchers also used short inpatient stays as a marker of potentially unnecessary hospitalizations. They found that hospitalized patients of female physicians were not more likely to have short inpatient stays than those treated by male physicians. 

At the same time, the additional care by female physicians was not associated with lower mortality rates. "We found no differences in mortality from this additional care, but mortality rates don't tell the whole story," said Ly, lead author of the study published in JAMA Internal Medicine. 

Previous research also has shown that female physicians order more diagnostic testing, but those analyses focused on primary care doctors. Studying ED physicians gives a clearer picture of patterns, as these patients have less opportunity to select their physicians.

To conduct the study, researchers analyzed a database of more than 1.5 million emergency department visits by veterans and compared patients cared for by female physicians versus male physicians working in the same EDs. The team examined differences in diagnostic testing and hospital admission rates between the two groups. They found female physicians ordered 3 to 5% more laboratory and imaging tests, and they also hospitalized 3 to 5% more patients than male physicians. 

The study raises questions about how physicians balance diagnostic uncertainty and resource use, the authors said. Future research may explore what causes the differences in how female and male physicians provide care, such as differences in risk aversion. Future research may also explore whether these differences lead to differences in patient health that are not captured by mortality numbers, such as missed diagnoses and quality of life.