The Surprising Demographics of Physician Mortality

In every country in the world, demographic data show that women tend to live longer than men. But that pattern may not hold true among U.S. physicians, according to HMS researchers.

“It’s beneficial to be a woman from a mortality perspective,” says Anupam Jena, the Joseph P. Newhouse Professor of Health Care Policy in the Blavatnik Institute at HMS and an HMS professor of medicine at Massachusetts General Hospital. “But that benefit doesn’t accrue if you’re a woman in medicine.”

Jena and frequent collaborator Christopher Worsham, an HMS assistant professor of medicine at Mass General, often explore how circumstances and luck affect medical outcomes. In many cases they draw from publicly available datasets — so in 2020, when the Centers for Disease Control and Prevention began publishing statistics linking death certificates to occupational roles, they saw an enticing opportunity.

“It was the first time that this data had been released on a very large scale,” Jena says. “It allowed us to study all sorts of interesting questions about occupational mortality hazards.”

First, along with colleagues including lead author Vishal Patel, a surgery resident at Brigham and Women’s Hospital, the researchers revealed that taxi drivers — who frequently exercise the hippocampal regions of their brains for spatial navigation — were less likely to die of Alzheimer’s disease than people in any other profession. The work corroborated intriguing observations from a U.K. study that found increased hippocampal volume among cabbies 25 years ago.

Next, they turned their lens on the medical profession. It had been decades since researchers had examined mortality rates among U.S. physicians, and most previous studies had only included men or explored single causes of death.

In a recent study, they decided to compare the mortality rates of physicians and other health care workers with those of non-health-care workers across different income levels and to explore how variables like sex and race might come into play. The study, published in May in JAMA Internal Medicine, offers the first comprehensive national estimates of mortality rates among physicians and other health care workers.

One takeaway is good news for doctors: Physicians had a lower mortality rate than those in other occupations, including in high-income professions like law, science, and engineering. “Physicians have better access to medical care, perhaps because of who they are, what they’re plugged into,” says Jena. “That might confer some health benefit — no surprises there.”

But the researchers were more surprised when they zoomed in on how sex and race influenced physician mortality.

While females who did not work in health care were 45 percent less likely to die than their male counterparts during the three-year study period from 2020 through 2022, that mortality advantage was almost entirely absent among female physicians, who did not experience a statistically significant difference in mortality as compared to male physicians. For certain causes of death, including cancer and chronic respiratory diseases, female physicians actually experienced higher mortality rates than males — patterns that were not observed in the general population.

“Another way to put it is that even though women live longer in medicine than women in law or engineering or science,” Jena says, “they don’t live as long as you would’ve expected given what we observe between women and men in the rest of society.”

The findings were even more stark for Black female physicians, who experienced higher mortality rates than all other physician subgroups. While Black physicians of both sexes had more than double the mortality rate of white physicians, that difference was compounded among Black female physicians, who were 128 percent more likely to die during the study period than white female physicians.

“If you’re a Black woman physician, you actually do no better than a white woman in the general population,” Jena says. “That means the benefit of being a physician because of your access to health care and your medical knowledge is wiped away.”

The findings are striking because traditional explanations for health disparities, like lack of education or economic opportunity, are arguably less relevant to physicians. But Jena points out that there is substantial evidence of workplace discrimination in medicine and that even doctors are not immune from the broader effects of structural racism in society at large.

As for the higher-than-expected mortality rate among female doctors in general, the researchers have a few ideas about what could be going on. One is selection bias: Perhaps the women who decide to become doctors somehow have different health risk factors than women who become lawyers or engineers.

Another is that there’s some effect of medicine itself that changes the experience of women in medicine versus in law or engineering. The most obvious, Jena suggests, is the concept of a “second shift.”

“If you’re a woman in medicine, you work long hours in the hospital, you train for many years, and then when you’re practicing, it can be very busy and stressful,” says Jena. “On top of that, you have additional work that has to be done when you get home, the type of work that is disproportionately borne by women — and that could be challenging for health.”

Previous research from Jena backs up this theory. In a 2017 study published in Annals of Internal Medicine, he and colleagues used census data to explore marriage patterns among doctors. They found that 17 percent of male doctors in the sample had married female doctors, while 31 percent of female doctors had married male doctors. Meanwhile, 46 percent of male doctors were married to people who didn’t work paid jobs outside the home, compared to only 9 percent of female doctors. In another study, they revealed that among couples consisting of two physicians, the women tended to spend more time on household work than the men.

The implication? “If you’re a man in medicine, there is sort of a clear division of household and non-household work, whereas if you’re a woman in medicine, you’re less likely to have a spouse doing most of the household work,” Jena says.

Although any attempt to explain the mortality disparities is speculation at this point, the research adds weight to a growing body of literature indicating that not all doctors have the same experiences or support. Other studies show that women physicians experience higher rates of burnout and sexual harassment, for example, and that they’re paid less than male colleagues for similar work. Jena says that even without the mortality data, it’s clear that women physicians need to be better supported — both inside and outside the workplace.

“The interventions that could help are probably things we should do anyway,” he says. “If the same problems are creating this mortality effect, then that’s just another reason that we should want to improve the experiences of women in medicine.”

Molly McDonough is the associate editor of Harvard Medicine.