Gender pay gap

As the medical profession becomes increasingly gender-balanced, pay equity has become an issue of increasing concern. Despite a significant amount of research on pay equity, until recently, relatively little was known about the pay gap in medicine, particularly in Canada.

The Ontario Medical Association’s governing Council instructed staff in 2019 to “initiate a thorough study of the sources and magnitude of physician-gender pay gaps in Ontario.” The OMA was the first provincial medical association to undertake such work.

A July 2020 report, Understanding Gender Pay Gap Among Ontario Physicians, was the first report in Canada to estimate a billings gap among a large physician population (31,481 physicians, who accounted for nearly all practising physicians in Ontario). [Editor’s note: The information in this report is from July 2020. Read the study published on Sept. 21, 2021 in JAMA Network Open.]

The report found that female physicians, on average, bill 13.5 per cent less on a daily basis than their male counterparts. The cause of such a prominent gap in billings remains perplexing, especially given the fee-for-service nature of most physician work. Research is underway to try to determine the causes of the gender pay gap.

Policy recommendations to reduce gender disparities among Ontario physicians

1. Address intersectional relativity

Female physicians are underrepresented in the higher compensated specialties. The impact of this underrepresentation on the gender pay gap is significant. An Ontario study by Cohen and Kiran (2020) examined differences in payments across specialties and found that gender composition was correlated with the average clinical payments received. In the EPR report, about 2/3 of the explained portion of the GPG was explained by the distribution of physicians across different specialties. Therefore, addressing intersectional relativity has the potential to significantly reduce the gender pay gap in Ontario.

2. Address fee relativity

The other key aspect of addressing the GPG, especially as it relates to intra-sectional gender equity, relates to fee relativity. This concern takes two main forms. First, there are examples where a service provided predominantly by female physicians is remunerated substantially less than a comparable service provided predominantly by male physicians. Second, there are some concerns that female physicians spend more time with patients and/or treat more complex cases than men but are remunerated at the same rate. The most appropriate method to address these issues is through a revision of the Schedule of Benefits. This may include evaluating fee codes in terms of their time, complexity, intensity, etc. so that a similar service is remunerated the same regardless of physician gender. Related to this, the definition and remuneration of fee codes should be further differentiated (e.g., based on time and complexity) to ensure that similar services are paid the same.

3. Raise awareness

The Membership survey results (despite the low response rate of 2 per cent) suggest the need for greater awareness of the GPG issue, particularly among male members. For example, only 34 per cent of male respondents agree that a gender pay gap exists (compared to 84 per cent among female respondents) and only 14 per cent of males are very concerned about the gender pay gap (compared to 75 per cent among females). This gender-biased response may be due in part to lack of awareness of the existing evidence on the GPG. Specifically, several recent studies document a significant GPG among physicians, and this body of evidence needs to be better disseminated among OMA members in a targeted awareness campaign.

4. New research: Referral networks

Gender-biased views on the GPG may also be related to a lack of solid, Ontario-based evidence on some key potential causes of the GPG. One such example is the impact of referral networks, for which there is some U.S. evidence, but further research is needed to understand the problem in Ontario and devise Ontario-specific recommendations. This issue represents the immediate next research topic on the EPR research agenda, given its perceived importance in addressing the GPG and given that the EPR has access to data required to conduct this research rigorously.