Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts (I.G.).
Brigham and Women's Hospital, Boston, Massachusetts (K.L.M.).
Ann Intern Med. 2022 Aug;175(8):1135-1142. doi: 10.7326/M22-0664. Epub 2022 Jul 19.
The physician gender wage gap may be due, in part, to productivity-based compensation models that undervalue female practice patterns.
To determine how primary care physician (PCP) compensation by gender differs when applying existing productivity-based and alternative compensation models.
Microsimulation.
2016 to 2019 national clinical registry of 1222 primary care practices.
Male and female PCPs matched on specialty, years since medical school graduation, practice site, and sessions worked.
Net annual, full-time-equivalent compensation for male versus female PCPs, under productivity-based fee-for-service, panel size-based capitation without or with risk adjustment, and hybrid payment models. Microsimulation inputs included patient and visit characteristics and overhead expenses.
Among 1435 matched male ( = 881) and female ( = 554) PCPs, 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]).
Panel attribution based on office visits.
The gender wage gap varied by compensation model, with capitation risk-adjusted for patient age and sex resulting in a smaller gap. Future models might better align with primary care effort and outcomes.
None.
医生的性别薪酬差距可能部分归因于基于生产力的薪酬模式，这种模式低估了女性的实践模式。
确定在应用现有的基于生产力和替代薪酬模式时，男女初级保健医生（PCP）薪酬的差异。
微观模拟。
2016 年至 2019 年，全国 1222 个初级保健实践临床登记处。
在专业、医学院毕业年限、实践地点和工作时间上与男性 PCP 相匹配的男性和女性 PCP。
基于生产力的按服务收费、无或有风险调整的按人头付费、混合支付模式下男性与女性 PCP 的净年薪、全职等效薪酬。微观模拟输入包括患者和就诊特征以及间接费用。
在 1435 名匹配的男性（n=881）和女性（n=554）PCP 中，女性 PCP 小组的患者平均年龄较小，基于诊断的风险评分较低，女性患者更多，未参保或通过医疗补助而不是医疗保险参保的患者更多。在基于生产力的支付下，女性 PCP 的收入中位数比男性 PCP 低 58829 美元（四分位距 [IQR]，39553 美元至 120353 美元；21%）。人头付费下的差距类似（58723 美元 [IQR，42141 美元至 140192 美元]）。仅按年龄（74695 美元 [IQR，42884 美元至 152423 美元]）、基于诊断的评分（114792 美元 [IQR，49080 美元至 215326 美元] 和 89974 美元 [IQR，26175 美元至 173760 美元]）以及按年龄、性别和基于诊断的评分（83438 美元 [IQR，28927 美元至 129414 美元] 和 66195 美元 [IQR，11899 美元至 96566 美元]）进行风险调整后的差距更大。按人头付费并按患者年龄和性别进行风险调整后的差距较小且无统计学意义（36631 美元 [IQR，12743 美元至 73898 美元]）。
基于就诊次数的小组归属。
薪酬模式的性别薪酬差距不同，按人头付费并按患者年龄和性别进行风险调整后的差距较小。未来的模型可能更符合初级保健的工作和成果。
无。
