Exploring the Gender Pay Gap in Primary Care

By Karen Joynt Maddox, MD, MPH
October 16, 2020

Since 1849, when Elizabeth Blackwell became the first woman to graduate from a U.S. medical school, up through the present, when more than half of medical school graduates are female, there have been gender issues in medicine. The gender gap in physician pay is well-documented, and at the same time, a growing number of studies suggest that female physicians may provide higher quality care and achieve better patient outcomes than their male colleagues.

recent study published in the New England Journal of Medicine by Ishani Ganguli, Hannah Neprash and colleagues adds a fascinating piece of information to this discussion that might be the bridge that links these two seemingly unrelated facts together. The authors used national claims and electronic health record data from primary care office visits to examine revenue generated, as well as the hours spent in direct patient care per visit, per day and per year, for women versus men.

They found that, on average, female primary care physicians (PCPs) generated 11% less revenue than male PCPs driven mostly by the fact that women conducted 11% fewer visits on an annual basis. However, despite conducting fewer visits, the female physicians actually spent 2.6% more time per year with patients because they spent, on average, 15.7% more time per visit with their patients than men.

The fascinating thing about this study is that even though it didn’t look directly at physician compensation, it suggests an explanation for why women make less than men in medicine, despite having very similar jobs (most PCPs’ pay is driven in part by productivity). And while it also doesn’t specifically address outcomes, prior work suggests that longer visits may be associated with higher quality care delivery, opening the door to further research on why female physicians achieve better outcomes on average for their patients.

In this era of ever-more financial pressure for clinicians to increase their clinical volume, this study should serve as a cautionary note: Preserving adequate time for patient visits is crucial, not just for its potential effect on patients, but also its effect on female physicians.

Karen Joynt Maddox is a cardiologist and co-director of the Center for Health Economics and Policy at Washington University in St. Louis. Her research interests include improving the measurement of physician, hospital and health system quality. 

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