Women primary care docs spend more time with patients, generate less revenue

Women primary care physicians spend more time with patients and conduct fewer visits on average compared to their male colleagues, which is likely contributing to the profession's gender pay gap, according to a new study.

Research shows women physicians earn 8 to 29% less than their male counterparts. Some have suggested the gap could be explained by female doctors working fewer hours on average than their male peers, a conclusion that has been supported by research relying mostly on physician survey data. The new study, published in the New England Journal of Medicine, uses claims and electronic health record data, and found while women physicians in primary care work on average 2.6% fewer days per year than their male colleagues in the same practice, they spend on average 2.6% more time with patients and provide 10.8% less visits over a year.

The findings suggest that the gender pay gap for primary care physicians can be partly explained by female doctors having longer visits with patients, said Hannah Neprash, the study's senior author and assistant professor of health policy and management at University of Minnesota's School of Public Health. That added time means they can't complete as many visits in a day, which leads to lower revenue overall in fee-for-service payment. The analysis also found per day in the clinic, female physicians generated 10.1% less revenue on average than their male colleagues.

The study "really challenges the assumption that the pay gap is due to female physicians working part time or just working less," Neprash said. "We actually see the pay gap is accompanied by spending more time with patients. It's a little bit surprising because it counters the usual narrative."

Additionally, the study found women doctors were slightly less likely than male doctors to bill codes for higher-intensity visits, which usually generate more revenue, even if they qualified to do so.

Neprash said the finding only accounts for a small share of the difference in revenue between male and female doctors, but it's worth noting, especially because the doctors were being compared to colleagues in the same practice.

As healthcare continues to develop new payment models that rely less on volume of visits, Neprash said the study findings suggest that may help address the gender pay gap.

"There are a lot of arguments to moving away from fee-for-service and we kind of provide one more reason why (its) a flawed system," she said.

The study examined about 24.4 million primary care visits in 2017 involving 8.5 million patients and 8,302 primary care doctors across the country. About 36.4% of the doctors in the study were female. All-payer claims data and electronic health record data were supplied by athenahealth.