Health Equity

A new study released July 19 posits that the shift to value and outcomes based care may increase the female physician wage gap.

See the study here.

The authors, who were from Harvard Medical School and Brigham and Women's Hospital, used data from more than 1,200 primary care practices nationwide. Based on this dataset, the researchers found that female primary care physicians made 21% less than male physicians in a fee-for-service model. Using a simulation of physician pay under a capitated payment model, they studied whether value-based care models would reduce this gap. Instead, they found that the pay gap actually increased in some scenarios and generally remained the same.

The authors concluded that the risk adjustment scores disadvantaged the average female physician for a few reasons. First, on average, female physicians see younger patients who tended to be female and were more likely to be uninsured or be on Medicaid. Compared with male physicians, the female patient population had lower risk scores despite being just as likely (if not more likely) to be associated with consequences of social determinants of health.

A second factor was the number of patients. Female physicians on average tend to see patients for longer visits and thus see fewer patients during the day. This also reduced reimbursement. Only when researchers evened out the age and gender of patients did the pay gap close.

As one of the authors told Axios, "We're moving toward this value-based payment. But are we really measuring and accounting for the right things?"