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

Abstract

The physician gender wage gap may be due, in part, to productivity-based compensation models that undervalue female practice patterns. To determine how primary care physician (PCP) compensation by gender differs when applying existing productivity-based and alternative compensation models. Microsimulation. 2016 to 2019 national clinical registry of 1222 primary care practices. Male and female PCPs matched on specialty, years since medical school graduation, practice site, and sessions worked. Net annual, full-time-equivalent compensation for male versus female PCPs, under productivity-based fee-for-service, panel size-based capitation without or with risk adjustment, and hybrid payment models. Microsimulation inputs included patient and visit characteristics and overhead expenses. Among 1435 matched male (n= 881) and female (n= 554) PCPs, female PCP panels included patients who were, on average, younger, had lower diagnosis-based risk scores, were more often female, and were more often uninsured or insured by Medicaid rather than by Medicare. Under productivity-based payment, female PCPs earned a median of $58829 (interquartile range [IQR], $39553 to $120353; 21%) less than male PCPs. This gap was similar under capitation ($58723 [IQR, $42141 to $140192]). It was larger under capitation risk-adjusted for age alone ($74695 [IQR, $42884 to $152423]), for diagnosis-based scores alone ($114792 [IQR, $49080 to $215326] and $89974 [IQR, $26175 to $173760]), and for age-, sex-, and diagnosis-based scores ($83438 [IQR, $28927 to $129414] and $66195 [IQR, $11899 to $96566]). The gap was smaller and nonsignificant under capitation risk-adjusted for age and sex ($36631 [IQR, $12743 to $73898]). Panel attribution based on office visits. The gender wage gap varied by compensation model, with capitation risk-adjusted for patient age and sex resulting in a smaller gap. Future models might better align with primary care effort and outcomes. None.