BACKGROUND AND PURPOSE:

• Female physicians continue to be paid less than their male counterparts
• Ganguli et al. (Ann Intern Med, 2022) determined how Primary Care Physician (PCP) compensation by gender differs when applying existing productivity-based and alternative compensation models

METHODS:

• Microsimulation study
  • Data from national clinical registry of 1222 primary care practices (2016 to 2019)
• Population
  • Male and female PCPs were matched by
    • Specialty | Years since medical school graduation | Practice site | Sessions worked
• Simulations
  • Productivity-based fee-for-service | Panel size–based capitation
    • Without or with risk adjustment
  • Hybrid payment models
• Study design
  • Microsimulation inputs included patient and visit characteristics and overhead expenses
• Primary outcome
  • Net annual, full-time-equivalent compensation for male versus female PCPs under the different simulations

RESULTS:

• Male PCPs: 881 | Female PCPs: 554
  • Female PCP panels included patients who, on average
    • Were younger
    • Had lower diagnosis-based risk scores
    • Were more often female
    • Were more often uninsured or insured by Medicaid rather than by Medicare
• Under productivity-based payment
  • Female PCPs earned 21% less than male PCPs
  • Median income difference: $58,829 (IQR, $39,553 to $120,353)
• Gap was similar under capitation without adjustment
  • Median income difference: $58,723 (IQR, $42,141 to $140,192)
• Wage gap was larger under capitation risk-adjusted for
  • Age alone
    • Median income difference: $74,695 (IQR, $42,884 to $152,423)
  • Diagnosis-based scores alone (Charlson Comorbidity Index [CCI])
    • Median income difference: $114,792 (IQR, $49,080 to $215,3260)
  • Age-, sex-, and diagnosis-based scores (CCI): Median income difference: $83,438 (IQR, $28,927 to $129,414)
• The wage gap was small and nonsignificant under capitation risk-adjusted for age and sex
  • Median income difference: $36,631 (IQR, $12,743 to $73,898)

CONCLUSION:

• Within a productivity-based model, female Primary Care physicians earned 21% less vs male colleagues
• The authors state

We found that despite female PCPs likely working similar hours to or even more hours than their male counterparts, female PCPs received less compensation under productivity-based payment due to conducting fewer visits

These lower visit rates may be explained by female PCPs spending more time per visit, or being less likely to work with nurse practitioners or physician assistants billing under their NPIs

Learn More – Primary Sources:

How the Gender Wage Gap for Primary Care Physicians Differs by Compensation Approach: A Microsimulation Study