Female physicians represent a growing share of the workforce, yet studies consistently show that they earn up to 30% less than their male counterparts. New research published in the New England Journal of Medicine from the School of Public Health (SPH), Harvard Medical School and athenahealth, Inc. provides new evidence about the origins of the gender pay gap in medicine. The study found that female primary care physicians (PCPs) earn less revenue for the care they provide, but spend more time with patients than their male colleagues, dispelling the commonly held opinion that female physicians work fewer hours than men.

The researchers used a novel combination of all-payer insurance claims and electronic health record data from athenahealth, Inc. and constructed measures of patient care revenue, visit volume, and visit length (in minutes) over the course of 2017.

Adjusting for physician, patient, and practice characteristics, the study found:

• Annually, female primary care physicians earned 10.9% less total visit revenue than male physicians and conducted 10.8% fewer visits, yet they spent 20 additional hours (2.6% more visit time) with patients.
• At the visit-level, revenue was identical for male and female PCPs, but female PCPs placed more orders, documented more diagnoses, and spent 2.4 minutes (15.7%) longer with their patients. Longer individual visits meant lower annual visit volume, resulting in lower total revenue for female physicians.
• The additional time spent in each appointment means that, on average, female PCPs were paid 87 cents to the dollar per hour of face-to-face work, compared to male PCPs.

“It all comes down to time,” says study co-lead and senior author Hannah Neprash, an assistant professor in SPH. “The disconnect between time spent and revenue generated may help to explain why female physicians — especially PCPs — face greater potential for job burnout. For example, female PCPs may experience declining morale because they may want to spend extra time with their patients; feel pressure from their employers to treat more people; and earn less money despite doing more work.” 

The results also suggest actions that healthcare organizations and policymakers can take, whether it’s paying physicians for something other than productivity (i.e., how many patients they see) or better compensating physician time as an input to medical care. However, researchers note that further study is needed to understand the relationship between visit length and quality of care.