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I am all for closing the gender pay gap in medicine. I am not surprised that researchers have found gender discrimination in “medical school hiring, promotion, and clinical care arrangements”. However, to state that “the gender pay gap in medicine is not explained by woman working fewer hours or less efficiently” does not add up. What is missing from this article is the difference in the number of patients seen per day between female and male physicians. I will make the assumption that most physicians in Canada obtain almost 100% of their income from fee for service. Both male and female physicians get paid the same fees for the same codes. If women are only working 4.7% less hours per day, then the only possible explanation for the majority of the 30% difference in family physician pay and the 40% difference in specialist pay can be due to seeing less patients per day or possibly less procedures per patient. There is no other way to explain this. Maybe female physicians are encouraged to seek specialties that pay less per patient and the fee schedule may pay more for scrotal surgery than labial surgery. This seems irrelevant when you consider that up until recently, the majority of physicians performing these procedures were men and men are still performing a large proportion of these procedures.
I believe the key take away from this article is in their statement, “In outpatient settings, woman generally spend more time per patient and deal with more issues per visit than men, which leads to the lower billing in a fee-for-service model.” I believe this is the main issue but the authors seem to have purposely left the fee-for-service billing data out of their article, most likely to try and make a better case for gender discrimination. To have an informed discussion on this topic we need to have this data.
I agree that reworking of the basis of payment for physicians is required. I disagree that making labial surgery pay the same as scrotal surgery is going to make any significant difference for women.
The fundamental problem with our fee-for-service system is that it rewards physicians for “assembly line” care. In regards to non-surgical visits, the fee-for-service system penalizes the physician who takes time with their patient. The word “doctor” comes from the latin “docere” which means “to teach”. Teaching a patient how to get healthy and stay healthy takes time. We need to empower our patients with this knowledge so they are not dependant on having to see their doctor every time they get sick. If female physicians are doing this more than male physicians then we don't just need to support them, we need to emulate them. However, I do not think the fee for service system discriminates against female physicians. I believe it discriminates against all physicians who are taking the time to practice medicine properly and it needs to be changed.