New collaborative research with Waymark, published in the journal Annals of Internal Medicine
The wage gap between male and female primary care providers may be due, in part, to productivity-based compensation models that undervalue female practice patterns. We sought to determine how primary care physician (PCP) compensation by gender differs when applying existing productivity-based and alternative compensation models. Using a national clinical registry of 1222 primary care practices, we found that female PCP panels included patients who were, on average, younger, had lower diagnosis-based risk scores, were more often female, and were more often uninsured or insured by Medicaid rather than by Medicare. Under productivity-based payment, female PCPs earned a median of $58 829 (interquartile range [IQR], $39 553 to $120 353; 21%) less than male PCPs. This gap was similar under capitation ($58 723 [IQR, $42 141 to $140 192]). It was larger under capitation risk-adjusted for age alone ($74 695 [IQR, $42 884 to $152 423]), for diagnosis-based scores alone ($114 792 [IQR, $49 080 to $215 326] and $89 974 [IQR, $26 175 to $173 760]), and for age-, sex-, and diagnosis-based scores ($83 438 [IQR, $28 927 to $129 414] and $66 195 [IQR, $11 899 to $96 566]). The gap was smaller and nonsignificant under capitation risk-adjusted for age and sex ($36 631 [IQR, $12 743 to $73 898]). Overall, capitation risk-adjusted for patient age and sex resulted in a smaller gap in compensation between male and female providers, and might better align with primary care effort and outcomes.
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