Payment for Patient Volume Rather Than Value Driver of Physician Gender Pay Gap

Research shows that female physicians spend more time with patients compared to their male counterparts.

Payment models that emphasize productivity and volume of patients seen are a primary cause of the physician gender pay gap, a healthcare finance professor says.

A recent Doximity report found a significant gender pay gap among physicians, with male doctors earning $110,000 more than their female counterparts. This represents a 26% gender pay gap in 2022, compared to a gender pay gap of 28% in 2021.

"There is increasing attention and research in this area. In the most recent research published in the New England Journal of Medicine, the study found that female primary care physicians earn less for the care that they provide but spend more time with their patients than their male colleagues," says Richard Priore, ScD, MHA, a clinical associate professor in the Department of Health Policy and Management at Tulane University.

The New England Journal of Medicine study found that female primary care physicians spent 15.7% more time with patients compared to their male counterparts. "The challenge for female physicians is they are spending more time with their patients and getting paid less," Priore says.

Female physicians appear less inclined to bow to the financial pressure of productivity-based business models at physician practices, he says. "Physicians have increasingly been put into a business mode, where there is pressure to see more patients in less time. My suspicion is that female physicians have not responded to this pressure in the same way male physicians have."

The physician gender pay gap is not the result of female clinicians putting in less effort than male clinicians, Priore says. "The New England Journal of Medicine study found that female physicians are not working less than their male counterparts—they are working just as hard as men are."

Payment reform is part of the solution to fixing the physician gender pay gap, he says. "We need to fundamentally change the way that physicians and hospitals are paid, and we need to increasingly pay for outcomes such as clinical outcomes and managing chronic conditions to keep patients out of the hospital. We need to address this issue to focus on wellness, prevention, and primary care."

More work needs to be done to understand the physician gender pay gap problem and to find solutions, Priore says. "There needs to be more research in the area in order to understand the problem. There needs to be more media attention and national research, whether it is from the National Institutes of Health or private foundations looking into this. We need to find out more about other underlying reasons for the physician gender pay gap. There also needs to be more senior leaders in health systems asking the question and being prepared to address the answers, especially if the answers are unpopular or do not paint the health system in a good light."

Related: Study Finds $2 Million Career Gender Pay Gap for Physicians