Do value-based models feed into medicine’s gender pay gap?

The pay gap between men and women is prevalent in most fields of employment in the United States. The estimate of the pay gap has women across all fields making roughly 80% of what men make, and this figure grows larger when subdividing by race. The field of medicine does fare better, with estimates of the pay gap falling around 25%

While it’s hard to nail down the primary drivers of gender pay gaps,  factors like choice of field, lower self-efficacy when advocating for raises, family, and unconscious bias all emerge as potential pieces of the puzzle. To control for these many variables, some studies have attempted to pair their participants as closely as possible to look for the presence of the gender pay gap in smaller sections of the population. One of these recent studies looked at primary care physicians to analyze how payment models value male versus female practice patterns. In medicine in particular, it appears that the pay gap may be due to the design of payment models themselves.

Compensation models can open and close the gap

In general, female and male primary care physicians (PCPs) differ in a few key ways that impact their compensation. According to a study from the Annals of Internal Medicine, female PCPs tend to have younger, female patients who are uninsured or insured by Medicaid instead of Medicare. Their patients tend to have diagnoses that are consequences of social determinants of health, equating to time-consuming care that is also rated with lower risk scores.

The extra time female physicians spend on their younger, “healthier” patients is directly impacting their compensation. This study indicates that the pay gap specifically between PCPs is around 21%, but other estimates have reached up to 25%.

“It’s not that women patients took more time, it’s that women doctors spend more time with all of their patients. It’s really about the different ways men and women doctors work.”

Lead Investigator Ishani Ganguli in Axios

The findings of Ganguli’s study indicate that capitated payments based on diagnosis or sex of the patient increased the pay gap, whereas risk-adjusting for both age and sex of patients can reduce this disparity. Capitation models were developed with the intention of leveling the playing field in terms of physician compensation, but these findings indicate that we should be cautious regarding unintended consequences of our chosen payment models. 

Ensuring appropriate compensation for physicians is a key part of maintaining a healthy, satisfied workforce. If we are penalizing female physicians for spending more time with their patients, and this study indicates that may be the case, then we need to pivot towards a model with better incentives than high patient volume.