Abstract
Men and women should earn equal pay for equal work. An examination of the magnitude of pay disparities could inform strategies for remediation. To examine gender-based differences in pay within a large, comprehensive physician population practicing within a variety of payment systems. This cross-sectional study used data from the Ontario Health Insurance Plan (OHIP) in the 2017 to 2018 fiscal year to estimate differences in gross payments between men and women physicians in Ontario, Canada. Pay gaps were calculated annually and daily. Regression analyses were used to control for observable practice characteristics that could account for individual differences in daily pay. In Canada's largest province, Ontario, medical services are predominantly provided by self-employed physicians who bill the province's single payer, OHIP. All physicians who submitted claims to OHIP were included. Data were analyzed from January 2020 to July 2021. Physician gender, obtained from the OHIP Corporate Provider Database. Gender is recorded as male or female. Gross clinical payments were tabulated for individual physicians on a daily and annual basis in conjunction with each physician's practice characteristics, setting, and specialty. A total of 31 481 physicians were included in the study sample (12 604 [40.0%] women; 18 877 [60.0%] men; mean [SD] time since graduation, 23.3 [13.6] years), representing 99% of active physicians in Ontario. The unadjusted differences in clinical payments between male and female physicians were 32.8% (95% CI, 30.8%-34.6%) annually and 22.5% (95% CI, 21.2%-23.8%) daily. After accounting for practice characteristics, region, and specialty, the overall daily payment gap was 13.5% (95% CI, 12.3%-14.8%). The pay gap persisted with differing magnitudes when examined by specialty (ranging from 6.6% to 37.6%), practice setting (8.3% to 17.2%), payment model (13.4% to 22.8% for family medicine; 8.0% to 11.6% for other specialties), and rurality (8.0% to 16.5%). This cross-sectional study examined differences in magnitude of annual and daily payment gaps and between unadjusted and adjusted gaps. Comparing the gaps for different specialties, geography, and payment systems illustrated the complexity of the issue by showing that the pay gap varied for physicians in different practice settings. As such, multiple directed interventions will be necessary to ensure that all physicians are paid equally for equal work, regardless of gender.
Highlights
As a principle of fairness, men and women should earn equal pay for equal work
Comparing the gaps for different specialties, geography, and payment systems illustrated the complexity of the issue by showing that the pay gap varied for physicians in different practice settings
In Ontario, Canada, family physicians (FPs) are compensated by a variety of models, including fee-for-service (FFS), capitation, and Alternative Payment Plans (APPs), while approximately two-thirds of physicians in other specialties receive FFS payments and one-third are remunerated via APPs
Summary
As a principle of fairness, men and women should earn equal pay for equal work This presents a challenge for the medical profession, as evidence worldwide indicates that gender pay disparities in medicine are pervasive. An annual Medscape survey of full-time US physician salaries recently reported raw gender pay gaps of 20% for family physicians (FPs) and 24% for other specialties.[1] In dollar terms, gap estimates controlling for productive factors, such as hours worked and years of experience, have been reported ranging from US $12 000 to US $76 000 yearly.[2,3,4,5] Gender-based pay gaps have been reported in multiple studies reflecting a variety of health systems and payment frameworks worldwide, with estimates ranging from 7% to 32%.6-11. After controlling for available productive factors, the gap was 23% These studies have established that gender disparities in physician earnings are present even in the FFS payment system, which many see as gender neutral.
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