On his blog, Benjamin Brown MD, does an incredible job detailing what he calls The…
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.
- 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.
- 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,
- 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?