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

Area of Science:

• Health Economics
• Medical Practice Management
• Gender Studies in Medicine

Background:

• Physician compensation models, particularly those based on productivity, may contribute to the gender wage gap.
• Female physicians' practice patterns might be undervalued in existing payment structures.

Purpose of the Study:

• To compare gender-based compensation differences for primary care physicians (PCPs) using various payment models.
• To evaluate how different compensation structures affect the male-female pay gap.

Main Methods:

• Microsimulation modeling was employed to analyze compensation.
• Data from a national clinical registry (2016-2019) of primary care practices were utilized.
• Matched male and female PCPs were compared across fee-for-service, capitation (with and without risk adjustment), and hybrid models.

Main Results:

• Under productivity-based payment, female PCPs earned 21% less than male PCPs.
• The pay gap remained substantial across various risk-adjusted capitation models.
• Capitation models risk-adjusted for patient age and sex demonstrated a significantly smaller gender pay gap.

Conclusions:

• The gender wage gap in primary care is influenced by the compensation model used.
• Risk adjustment for patient age and sex in capitation models can reduce pay disparities.
• Future compensation models should aim to better reflect primary care effort and outcomes for improved equity.