BackgroundThe relationship between male sex and poor performance in doctors remains unclear, with high profile studies showing conflicting results. Nevertheless, it is an important first step towards understanding the causes of poor performance in doctors. This article aims to establish the robustness of the association between male sex and poor performance in doctors, internationally and over time.MethodsThe electronic databases MEDLINE, EMBASE, and PsycINFO were searched from inception to January 2015. Backward and forward citation searching was performed. Journals that yielded the majority of the eligible articles and journals in the medical education field were electronically searched, along with the conference and poster abstracts from two of the largest international medical education conferences. Studies reporting original data, written in English or French, examining the association between sex and medico-legal action against doctors were included. Two reviewers independently extracted study characteristics and outcome data from the full texts of the studies meeting the eligibility criteria. Study quality was assessed using the Newcastle-Ottawa scale. A random effect meta-analysis model was used to summarize and assess the effect of doctors’ sex on medico-legal action. Extracted outcomes included disciplinary action by a medical regulatory board, malpractice experience, referral to a medical regulatory body, complaints received by a healthcare complaints body, criminal cases, and medico-legal matter with a medical defence organisation.ResultsOverall, 32 reports examining the association between doctors’ sex and medico-legal action were included in the systematic review (n=4,054,551), of which 27 found that male doctors were more likely to have experienced medico-legal action. 19 reports were included in the meta-analysis (n=3,794,486, including 20,666 cases). Results showed male doctors had nearly two and a half times the odds of being subject to medico-legal action than female doctors. Heterogeneity was present in all meta-analyses.ConclusionMale doctors are more likely to have had experienced medico-legal actions compared to female doctors. This finding is robust internationally, across outcomes of varying severity, and over time.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0413-5) contains supplementary material, which is available to authorized users.

ObjectivesTo examine the association between doctors’ sex and receiving sanctions on their medical registration, while controlling for other potentially confounding variables.DesignCross-sectional study.SettingThe General Medical Council (GMC)'s List of Registered Medical Practitioners (LRMP) database of doctors practising in the UK.PopulationAll doctors on the GMC's LRMP on 29 May 2013. The database included all doctors who are or have been registered to practise medicine in the UK since October 2005. The exposure of interest was doctor's sex. Confounding variables included years since primary medical qualification, world region of primary medical qualification and specialty.Outcome measuresSanctions on a doctor's medical registration. Sanction types included warnings, undertakings, conditions, suspension or erasure from the register. Binary logistic regression modelling, controlling for confounders, described the association between the doctor's sex and sanctions on a doctor's medical registration.ResultsOf the 329 542 doctors on the LRMP, 2697 (0.8%) had sanctions against their registration, 516 (19.1%) of whom were female. In the fully adjusted model, female doctors had nearly a third of the odds (OR: 0.37, 95% CI: 0.33 to 0.41) of having sanctions compared to male doctors. There was evidence that the association varies with specialty, with female doctors who had specialised as general practitioners being the least likely to receive sanctions compared with their male colleagues (OR: 0.26, 95% CI: 0.22 to 0.31).ConclusionsFemale doctors have reduced odds of receiving sanctions on their medical registration when compared with their male colleagues. This association remained after adjustment for the confounding factors. These results are representative of all doctors registered to practise in the UK. Further exploration of why doctors’ sex may impact their professional performance is underway.