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A microsimulation study found that female primary care physicians (PCPs) make 21 percent less income than their male counterparts under productivity-based compensation models, with capitation risk-adjusted for patient age and sex resulting in a smaller gap. The findings are published in Annals of Internal Medicine.
Female physicians are a growing proportion of the clinician workforce but are still paid less than their male counterparts. Part of this gap may be explained by compensation models that do not directly capture primary care effort and may favor traditionally male practice patterns. Compared with male physicians, female physicians conduct fewer but longer visits that involve more counseling and shared decision making and spend more time on non–face-to-face care. These attributes are valued by patients and may be linked to better outcomes but may not be valued by current payment models.
Researchers from Harvard Medical School and Brigham and Women’s Hospital conducted a microsimulation study of 1,435 matched male and female PCPs at 1,222 primary care practices. The authors found that under productivity-based payment, female PCPs earned a median of $58,829, or 21 percent, less in income than male PCPs. The gap was even bigger when using some other common compensation models. However, it was smaller and nonsignificant under capitation (that is, paying per patient cared for) that accounted for patient sex along with age. The authors also found that the wage gap could be partially explained by female PCPs conducting fewer visits and treating patients who skewed more female, slightly younger, and more often uninsured or covered by Medicaid than covered by Medicare. They calculate that despite conducting fewer visits and getting paid less, female physicians in the study likely spent the same number of hours per year in face-to-face patient care. . The authors conclude their results highlight the need for explicit conversations about the societal and professional values and intentions underlying a given compensation approach. They add that an alternative payment model such as age and sex-adjusted capitation that minimizes the gender wage gap, or future models that more directly capture primary care effort, may be beneficial not only from an equity standpoint but also for retention of the increasingly female primary care workforce that is already disproportionately subject to burnout.