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Analysis

Physician Gender Pay Gap May Be a Matter of Time, Study Finds

By Christopher Cheney  
   November 03, 2020

A recently published study found that female primary care physicians spend more time with patients than their male counterparts.

Female primary care physicians conduct fewer patient visits than their male counterparts but spend more time with patients, which helps to account for the physician gender pay gap, a recent research article found.

Several studies have shown that female physicians earn 8% to 29% less than male physicians. A report published last week by the physician network Doximity found that the wage gap between male and female physicians is 28% this year, with male doctors earning over $116,000 more annually than their female counterparts.

The recent research article, which was published by the New England Journal of Medicine, is based on an analysis of 24.4 million primary care office visits in 2017. The analysis of the office visits compared female and male clinicians in the same physician practices.

The study includes three key data points:

  • Female primary care physicians generated 10.9% less revenue from office visits compared to male PCPs
     
  • Female PCPs conducted 10.8% fewer patient visits over 2.6% fewer clinical days per year
     
  • Female PCPs spent 16% more time with patients than male PCPs

The additional time that female PCPs spend with patients relative to their male counterparts is a likely driver of the physician gender pay gap, the research article's co-authors wrote.

"We found that female PCPs generated nearly 11% less annual visit revenue than otherwise similar male PCPs in the same practices, yet they spent more time with patients per visit, per day, and per year. The revenue gap was driven entirely by differences in visit volume, which were only in small part explained by the fewer days that female PCPs saw patients. Taken together, these results suggest that the differences in time spent with patients may be a contributor to the gender pay gap, with female physicians effectively generating 87% of what male physicians generate per hour of direct patient care," they wrote.

Interpreting the data

The study has important implications for female physician work hours and compensating physicians based on patient visit volume, the research article's co-authors wrote.

"We found that female PCPs worked slightly fewer days per year and scheduled substantially fewer visits while—and possibly in part to compensate for—spending more time with patients per visit. Our finding that this additional time spent per visit translated into more time in direct patient care per day and per year challenges conventional assumptions that female physicians work fewer hours (even if they may also choose to schedule fewer visits on the basis of this aspiration). This finding also substantiates the common critique that volume-based productivity is an imperfect measure of physician work," they wrote.

The study also found significant billing differences between female and male PCPs. "Although female PCPs documented more diagnoses and placed more orders, they were more likely to miss opportunities to bill higher-paying visit codes on the basis of the time they had spent with patients, a finding that was consistent with the results of a study showing that female radiation oncologists billed fewer lucrative procedures than their male counterparts," the co-authors wrote.

In addition to providing insight into the physician gender pay gap, the study also may indicate why female physicians are more prone to burnout than male physicians, the co-authors wrote.

"Taken together, we found a nearly 11% gender gap in annual visit revenue among otherwise-similar physicians in the same practices. The gap was due primarily to male PCPs providing more visits, although female PCPs spent more time with patients per visit and overall. The disconnect between time spent and revenue generated may help to explain why female physicians (especially PCPs) face a greater risk of burnout than their male counterparts."

Related: Physician Gender Pay Gap: Link to Work-Life Balance Found Unlikely

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Several studies have shown that female physicians earn 8% to 29% less than male physicians.

The additional time that female primary care physicians spend with patients relative to their male counterparts is a likely driver of the physician gender pay gap, a recently publish study found.

The recent study found that female PCPs generate less annual visit revenue than their male counterparts. Combined with the finding that female PCPs spend more time with patients, the study supports criticism that volume-based productivity is a flawed measure of physician work.


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