Female Physician Pay Differences

I think this is another topic (female physician pay differences) that everyone will get crazy about. I am asking that my readers have a CIVIL discourse here. We do not have to behave like the rest of the world. Here is why we should talk about it:

  • It keeps coming up.
  • Uncomfortable conversations need to be had.
  • Disagreeing with someone doesn’t mean either side is evil.
  • Authentic Medicine rarely shies away from controversy.
  • We are all doctors and need to stick to together and not let them pit us against each other.

CNN, in their typical way, wrote an article whose aim was to cause chaos.

Study finds female doctors work harder for less money

Now, let’s highlight some important points from the piece to see if that is what it really said. I put my thoughts in parenthesis.

  • Female doctors spend more time with patients, order more tests and spend more time discussing preventive care than their male counterparts, a team of researchers reported in the New England Journal of Medicine. (More time is normally a good thing and so is discussing preventive care. More tests are NOT always a positive thing as we have seen with nondoctors.)
  • Ganguli and her team did not sit in on visits, so they cannot say precisely what is going on. “We are using clues from billing information about what orders are put in, like for blood tests, or what diagnosis was talked about,” she said. (This is a severe limitation to the study).
  • Per visit, after adjustment for primary care provider, patient and visit characteristics, female primary care providers generated equal revenue but spent 15.7% more time with a patient,” the team wrote.
  • “Although female primary care providers documented more diagnoses and placed more orders, they were more likely to miss opportunities to bill higher-paying visit codes on the basis of the time they had spent with patients, a finding that was consistent with the results of a study showing that female radiation oncologists billed fewer lucrative procedures than their male counterparts.” (So this comes down to billing knowledge, which is a teachable skill. Female physicians are not optimizing their billing).

So, first let me state that the system is broken and that is why I left it to do DPC. The whole RVU billing method is horseshit and it almost takes a Ph. D to learn it. It also favors procedural based medicine and penalizes primary care docs who take time with their patients.

Do the people who pay doctors discriminate against women? I don’t think this study shows that at all. Sorry. I know people will be pissed at me but let’s break this down.

  1. This study is not comparing negotiated contracts or guaranteed salaries that hospitals offer to male and female doctors. I believe there is evidence that these numbers are discriminative but that’s not the point here.
  2. This study is based on billing and style of medicine. It looks like women spend more time with patients than male doctors but male doctors may see more patients. This from the actual study: In 2017, female PCPs generated 10.9% less revenue from office visits than their male counterparts (−$39,143.2; 95% confidence interval [CI], −53,523.0 to −24,763.4) and conducted 10.8% fewer visits (−330.5 visits; 95% CI, −406.6 to −254.3) over 2.6% fewer clinical days (−5.3 days; 95% CI, −7.7 to −3.0), after adjustment for age, academic degree, specialty, and number of sessions worked per week,
  3. The way the billing system is set up favors seeing more patients and doing more procedures. I agree this is unfair to women but those are the rules, as stupid as they are.

So, does the study really show that “female doctors work harder for less money”? I don’t think so. Male doctors may not spend as much time (10% less) with each patient but they see more patients (10% more). And if women optimized their billing then everything may equalize.

IMHO, Women docs need to optimize their billing better, change the billing system as a whole, change their practice style, or go into DPC.

CNN was off the rails with this headline but that is nothing new in this clickbait world.

Now, can we be civil in our comments?

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected]

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12 Responses

  1. Bridget Reidy says:

    “So this comes down to billing knowledge, which is a teachable skill. Female physicians are not optimizing their billing.” I hear this type of statement a lot, but not from people who admit our billing system is terribly flawed. When so much of our work doesn’t contribute to billing, it really is not right to say putting in more time and not making more per hour is a problem caused by not learning how to bill well.

    I truly don’t understand why there is so much resistance (not here at least) when it is hypothesized that spending more time might be better, or more “productive”. Never mind the vitriol when it is hypothesized that women may not have a choice in spending more time due to patient expectations and/or nurse expectations.

    There is plenty of science in implicit bias to show that such should be expected, from women and men. (Woman supreme court justices are interrupted three times more than the men. How efficient would you be if interrupted three times more often? It’s not about attacking men no matter how many believe it is. It’s about improving billing systems and helping people be aware of their biases so they can be fair if so inclined.

    (I know of a women who surveyed docs on where the warm blankets are. The women knew and the men didn’t. Her experience offered an explanation. When patients ask female docs and they tell the nurse, they are shown where they are while the nurse just gets it when the man does. Add to that nursing complaints when female doctors don’t do as they’re told)

  2. Joe Smegma, DO says:

    Contractually most if not all male and female physicians working for the man (or woman) (hospital based RVU systems) are paid identically. Differences in practice style, time spent with patients, efficiency, number of procedures performed, and patient mix all impact productivity and therefore wages. Although time spent with patients is valuable it may not result necessarily in better care. Efficiency also matters. I know many physicians who spend so much time with patients that they do not do their documentation until the end of the day (take it home with them). This results in progress notes that are poor, less accurate and result in down coding. I agree with the DPC model as the panacea. No more coding, no more RVU’s, and more time to spend with your patients.

  3. Sarah Hathaway says:

    As a female physician, I routinely made more than my male counterparts. BUT, that is because I made a concerted effort to learn how to code my visits appropriately and also offered lots of procedures my patients wanted (colposcopies, IUDs, minor derm procedures, etc). I also mentored lots of male and female physicians. I found that many female physicians routinely undercoded for visits. It seemed like they were trying to be “nice”. Not me. I did well. I also did not tolerate late patients except under extreme circumstances.

    • Kurt says:

      No matter what the doctor gender it pays to learn to code well. I never did learn it very good but hey I was old and learned enough to retire at 63.

      I do want to point out that many female physicians cut back to be moms for their families, hence they get paid less. Nothing wrong with that. They want to be there for their family but they will get less $$$$. On the other hand, I know women physicians who bust their butt with work, do stuff like OB and by golly they made much more $$$$ than myself. By golly they danged well deserved it too!!

  4. Michele C Parker says:

    In our office we have very different patients in that women gravitate to women physicians and men to men (with shorter review of systems). And its better now that its only every 3 years, but there was a huge time difference in the pageantry involved in conducting a pap yearly! Someone should analyze patient gender and time/pay differences!

  5. MD says:

    The CNN article does indeed make a valid point, which I think does not get enough attention from the medical community. Female physicians are under pressure to be “nice” and “sympathetic;” this typically translates into spending more time with a patient whether we need to or not, because it’s less acceptable for us to redirect a patient who has gone off-topic, and because we are more likely to receive adverse patient satisfaction results if we cut patients short the way male physicians do.

    There is likely a side benefit to this behavior given other studies suggesting that cardiac patients seen by female physicians have better outcomes. However, as we don’t feel comfortable billing for this extra time (or in fact are reined in my our employers as I once was over an allowed but innovative billing practice), we end up getting paid less for more work.

    The converse is also true; male physicians are under pressure to look like “heros” for having high patient through-put numbers. I think if we were all honest with each other, it feels more impressive to brag “I saw fifty patients today!” than it is to brag “I picked up a rare diagnosis today!” All physicians are susceptible to taking pride in how many patients they can see in a day, but I think male physicians are more susceptible to making it a matter of competition.

  6. Deanna Barry says:

    And THIS is exactly why I just quit my job with a hospital system and am opening my DPC next month! I enjoy taking my time with my patients but was on a productivity based model. Good care killed my numbers. Yes, I did get a 20 page Excel sheet every month with columns and columns of numbers…

  7. Pat says:

    In our multi-hospital ER group, we are paid an hourly wage, so this is not an issue for our female colleagues.

    • Dr Susan Payson says:

      Are the hourly rates and bonuses etc open access for all members of the group? If the contract is the way mine was, there is wording forbidding me to ask what the other ER doctors were being paid. Just sayin

  8. PW says:

    I pay no attention to the media any longer. Their goal is to drive wedges between the sexes, the races, straights cs gays, rich vs poor, mask vs no mask. In a time when Americans should be able to band together, the media is trying to drive us apart, simply because it’s an election year.

    • Brian Dillon says:

      PW is on to Something, But is much bigger than the election. Remember only six companies control all the media you see. They am trying to run by just a few filthy rich families that are committed towards world globalism with cheap low IQ labor not to be impeded by silly things like civics, christianity, Juldiism the nuclear family, or especially men. Which are to be vilified. (Why do you think they set it up where women get welfare only if I don’t get married?) They only one of them for factory work and they outsource that to cheaper places. we know that fact a lot of things like border immigration , taking prayer, the Pledge of Allegiance, and the flag out of schools, bringing in Islam and feminism,start to make a lot of sense

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