Large VA emergency study finds different practice patterns by physician gender
A large UCLA Health study is adding nuance to a long-running debate over how much care is too much in the emergency department. Looking at more than 1.5 million emergency department visits in a veterans database, researchers found that female physicians ordered more imaging and laboratory tests and admitted more patients to the hospital than male physicians working in the same settings. But the study also found that the additional testing was just as likely to identify important findings, weakening the idea that the differences were simply a sign of waste.
The paper, published in JAMA Internal Medicine, focuses on a setting where patients generally have less ability to choose their clinician than they do in primary care. That matters because it gives researchers a cleaner way to compare physician behavior without the same level of patient self-selection that can complicate other analyses. The result is not a simple verdict that one group is practicing better than the other. Instead, it points to different approaches to diagnostic uncertainty in high-pressure clinical situations.
Lead author Dan Ly, an assistant professor of medicine at the David Geffen School of Medicine at UCLA and the VA Greater Los Angeles, said the findings suggest female and male physicians may respond differently when the clinical picture is unclear. In the emergency department, that uncertainty is common. Physicians often make decisions with limited patient history, limited time, and a wide range of possible explanations for the same symptoms.
What the researchers found
According to the study summary, female emergency physicians ordered about 3% to 5% more laboratory and imaging tests than male physicians. They also hospitalized 3% to 5% more patients. On the surface, those figures could be framed as a sign of more intensive care. But the researchers paired those measures with indicators meant to test whether the extra care was yielding useful information or avoidable admissions.
One of the key findings is that the added diagnostic testing was just as likely to uncover important findings. That matters because a higher volume of tests can be interpreted in very different ways depending on the yield. If more tests do not produce meaningful results, critics are more likely to see them as defensive medicine or unnecessary spending. In this case, the study summary says the additional testing did not appear to be less clinically productive.
The researchers also used short inpatient stays as a marker for potentially unnecessary hospitalization. Here too, the study did not find evidence that female physicians were admitting patients who were more likely to have very brief hospital stays than those admitted by male physicians. That finding does not prove every admission was necessary, but it does undercut a simple claim that higher admission rates automatically reflect lower-value care.
The study did not find lower mortality associated with the additional care. Ly noted that mortality alone is a limited measure for judging emergency treatment. Many clinically important benefits or tradeoffs in emergency medicine do not show up cleanly in mortality statistics, especially across a large and varied patient population.
Why the context matters
Previous research has found that female physicians tend to order more diagnostic testing, but much of that work centered on primary care. The emergency department offers a different lens. Patients arrive with acute complaints, incomplete records, and problems that can range from minor to life-threatening. Clinicians are often asked to rule out dangerous causes before they can safely discharge someone home.
That context makes practice-style differences especially important. A physician facing uncertainty can lean in several directions: observe longer, test more, admit for monitoring, or discharge with follow-up. None of those choices is automatically right or wrong across all cases. The UCLA study suggests female physicians may lean somewhat more toward testing and admission, but without clear evidence in this dataset that those decisions were obviously wasteful.
Because the study examined veterans, readers should be cautious about assuming the exact same patterns would appear in every emergency department nationwide. Veteran populations can differ from the broader public in demographics, health status, and care pathways. Even so, the scale of the analysis gives it weight. More than 1.5 million visits is large enough to move this discussion beyond anecdote.
Implications for hospitals and policymakers
For hospitals and health systems, the study is a reminder that utilization differences cannot be judged on volume alone. Administrators looking only at counts of tests or admissions may miss the clinical context behind those choices. If a higher-testing approach also produces meaningful findings at a comparable rate, the policy question becomes more complicated than simply cutting use.
The findings may also shape how health systems think about physician performance metrics. A narrow focus on reducing testing or admissions can backfire if it ignores diagnostic uncertainty, patient safety, or case mix. Emergency medicine is an environment where the cost of missing a serious condition can be high, and the study suggests that different physicians may balance that risk differently.
At the same time, the lack of a mortality difference means the results will not settle the broader debate over care intensity. Critics of higher utilization are likely to point out that more testing and more admissions still consume resources, and that equal rates of “important findings” do not by themselves prove the overall approach is optimal. Supporters of a more cautious style will counter that the data do not show the extra care was empty or clearly unnecessary.
What this study does and does not say
The most defensible takeaway is not that one group of physicians is better than the other. It is that differences in practice style exist, they are measurable at scale, and they should not be reduced to stereotypes about overuse without looking at clinical yield. In this dataset, female emergency physicians delivered somewhat more intensive care, but the summary provided does not show that the added care translated into more obviously unnecessary admissions or lower-value testing.
That leaves an important question for future research: if mortality is unchanged, what other outcomes should matter most? Patient reassurance, missed diagnoses, return visits, symptom improvement, length of stay, and total cost could all alter how these results are interpreted. For now, the UCLA study sharpens the debate by showing that more care is not automatically synonymous with worse care, especially in one of medicine’s most uncertain environments.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
