Women doctors spend more time with patients but generate less revenue, study finds

Women primary care physicians (PCPs) spend an average of 20 hours more per year with patients than their male counterparts, yet generate about 11% less in annual revenue from office visits, a new study finds.

The findings cast doubt on the widespread assumption that the gender pay gap is due primarily to women working less, while lending support to the argument that volume-based productivity is an imperfect measure of physician work.

Researchers used national all-payer claims and data from electronic health records to analyze results of 24.3 million patient visits conducted by 8,300 PCPs in 2017. They found that women physicians generated $319,652 in annual revenues, compared to $358,795 for men, a difference of 10.9%. But women spent only 5.3 fewer days in clinic than men, a difference of 2.6%.

The study also showed that women PCPs spent an average of 17.6 minutes with their patients, compared with 15.3 minutes for men, and placed slightly more orders and documented more diagnoses. On an annual basis, the difference in time spent with patients adds up to about 20 hours. Consequently, women scheduled an average of 10.8% fewer visits per year than men.

Based on these findings, the authors conclude that the revenue gap between male and female PCPs was due entirely to differences in visit volume, which in turn resulted from the disparity in time spent with patients.

Researchers also found evidence of gender-based differences in billing patterns. Despite documenting more diagnoses and placing more orders, the women PCPs were more likely to miss opportunities to bill higher-paying visit codes, a finding they say is consistent with a study showing that female radiation oncologists billed fewer lucrative procedures than their male counterparts.

The authors say that the disconnect between revenue generated and time spent may help to explain why women PCPs experience burnout at a higher rate than men. In addition, it hinders efforts to build and sustain an adequate number of primary care physicians, especially given that women account for a growing share of them.

On the other hand, they note, payment structures based solely on productivity can be modified in ways that would reduce the gender pay gap. They also encourage development of alternative compensation models, such as risk adjustment for panel size, and including measures such as outcomes and patient experience as methods for promoting compensation equity.

The study, “Physician Work Hours and the Gender Pay Gap—Evidence from Primary Care” was published in the October 1, 2020 issue of The New England Journal of Medicine.