Women family physicians in Ontario spend more time per patient, on average, than their male counterparts do, a new study indicated. This finding could help explain the pay gap between female and male family physicians in the province.
The results of a survey completed by 1055 family physicians revealed that for 19 of 20 common medical services, female family physicians reported longer average service times than their male counterparts. The difference between the two groups ranged from 15% to 20%. For the most frequently billed service (ie, intermediate assessment), female family physicians devoted an average of 3.9 minutes (22.3%) more than male family physicians. This difference was statistically significant.
The additional time that female family physicians spend with patients likely contributes to the pay gap between female and male family physicians in Ontario, according to lead author Boris Kralj, PhD, health economist and adjunct assistant professor in economics at McMaster University in Hamilton, Ontario.
“I think it’s 2 hours a day extra that a female [family physician] needs to work to make the same money” as a male family physician, Kralj told Medscape News Canada. “We feel that type of uncompensated time drives burnout.”
Only five respondents to the survey questionnaire identified as nonbinary, so the sample size was insufficient for a statistical analysis of this physician population.
The findings were published on January 14 in Canadian Family Physician.
Why the Difference?
Patient expectations and cultural norms have been offered as explanations for the sex-based difference in time spent per patient visit, said Kralj.
“Patients, particularly female patients, tend to expect female doctors to give them more time than male doctors,” said Kralj. Female physicians have a greater proportion of women in their patient rosters than male physicians. “Also, female doctors more than male doctors tend to focus on the patient’s psychosocial issues and their social circumstances.”
Interestingly, the difference between male and female family physicians in time spent per patient was not statistically significant among international medical graduates. “We know from other literature that your communication style and practice style are influenced by your training environment,” said Kralj. “The practice norms and communication norms in Canada may be different than they are in other countries.”
Time Affects Pay
The study authors pointed out that the current fee-for-service compensation model may result in lower hourly earnings for female family physicians because it matches compensation to the type of service delivered, as opposed to the time spent per patient. They suggested that a time-compensation payment model would address the pay gap.
“You can have the fee-for-service model but have different tiers or the same code based on time spent [with a patient],” said Kralj, adding that physicians should be able to select the compensation model they want for themselves.
The study’s limitations include nonresponse bias because not all Ontario family physicians participated in the study, as well as recall bias or measurement error, given that the duration of time spent on a patient visit was self-reported and could have been underestimated or overestimated.
Pay Inequity Persists
The study highlights the persistent pay inequity between men and women in family medicine, Tara Kiran, MD, family physician and scientist at St Michael’s Hospital, Unity Health Toronto, Toronto, told Medscape News Canada. Kiran, who did not participate in the study, and who also is the Fidani Chair of Improvement and Innovation at the University of Toronto in Toronto.
“A number of studies in the United States, Canada, and elsewhere have looked at this issue of the gender pay gap within medicine,” she said. Studies within Canada, specifically in Ontario, have confirmed the gap’s existence. One study in The New England Journal of Medicine concluded that female primary care physicians produce less visit revenue because of factors such as a decreased volume of patients and increased time spent on per patient.
In the analysis by Kralj and colleagues, 71.6% of respondents worked in a capitation model, said Kiran. Under this model, physicians receive a fixed annual payment for every patient added to their rosters, and variables such as patient age and complexity affect the amount of payment.
Nevertheless, the current study suggests that the difference in time leads to a gap in remuneration between male and female family physicians. It raises the question of prioritizing patient volume over time per patient, with respect to compensation, said Kiran.
The time difference “is a contributor to the gender pay gap because if women are spending more time with patients in a fee-for-service setting, [which] means that they are potentially seeing lower volumes,” said Kiran. “In a capitation setting, it potentially means that they are rostering fewer patients.”
The study was funded by the Canadian Institutes of Health Research. Kralj and Kiran reported having no relevant financial relationships.
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