Ontario’s physician wage-gap: Myth vs. fact

Given that most Ontario physicians are paid through OHIP billing, which uses a fee-for-service structure, and that billing codes do not account for sociodemographic characteristics such as age, sex or race of a physician, you may have the impression that the remuneration system is entirely objective and unbiased.

You would, however, be wrong; systemic biases can still result in inequitable remuneration.

Multiple studies have shown a significant wage gap between male and female physicians in Ontario. Some attribute the wage gap to unfounded assumptions regarding gender-specific practice patterns such as hours worked. Based on the principles of equity and justice, individuals should be paid equally for equal work, regardless of sex and/or gender. As such, rather than blaming female physicians, we must critically assess the systemic factors that lead to lower earnings and dispel myths about the physician wage gap.

Myth #1: There is no physician wage gap in Ontario. Female physicians earn less than male physicians simply because they work fewer hours.

Fact #1: In Ontario, female physicians earn 32.8 per cent less than male physicians annually. On average, male physicians worked 25.3 days more than female physicians annually, representing a 12.5 per cent difference in number of days worked. This is a small difference compared to the income discrepancy. As such, the wage gap cannot be fully explained by male physicians working more hours. After controlling for factors known to impact physician salary, including location of practice and speciality, the wage gap persists. The daily adjusted wage gap between male and female physicians is calculated to be 13.5 per cent per day.

Data from surgical specialities also contradicts the myth that wage-gap is due to the number of hours worked. Even with equal hours, female surgeons earn less than male surgeons in the same speciality. This may be partially explained by male surgeons having more opportunities to perform more lucrative surgical procedures compared to female surgeons who, on average, perform less lucrative surgical procedures. This trend is present in most surgical specialities. As a result, female surgeons earn 24 per cent less than male surgeons per hour of operating time. Since both male and female physicians undergo the same standardized training to be board certified, this discrepancy implies an undervaluation of female surgeons’ time compared to their male counterparts.

Female surgeons earn 24 per cent less than male surgeons per hour of operating time.

To achieve pay parity, female physicians would need to work significantly more than full-time hours, which could lead to increased burnout, simply to match the earnings of their male counterparts in many specialties. Suggesting that female physicians should simply “work more hours” wrongfully implies they are less hard-working or dedicated than their peers. In reality, female physicians earn less on an hourly and daily basis due to systemic inequities within the health-care system. Possible systemic factors contributing to this disparity may include implicit gender biases in hiring practices, pay negotiation and advancement. Implicit gender biases in mentorship and networking opportunities can limit women’s access to career advancement, further widening the pay gap. Moreover, societal expectations around caregiving may lead to women working fewer hours or taking more career breaks, which directly impacts their earning potential.

Myth #2: The physician wage gap is due to female medical students choosing to pursue less lucrative specialities than male medical students.

Fact #2: The physician wage gap is present when comparing male and female physicians within the same speciality. In Ontario, female physicians earn significantly less than male physicians in 20 out of 36 medical specialties studied. In 13 medical specialties, the adjusted daily income was lower by 15 per cent or more for female physicians. This is the case even though male and female physicians within the same specialty share equal scope and equal competencies.

Having established the persistence of the wage-gap even within specialties, we can consider the distribution of gender between specialties. It is true that many of the lower paying medical specialties have a higher proportion of female physicians, whereas male-dominated specialties tend to offer higher earnings. Consequently, we must ask why female medical students tend to pursue lower-paying medical specialities compared to their male counterparts. This includes examining the curricula in medical schools and hiring processes, as well as understanding how broader sociocultural expectations of women influence specialty choice.

Myth #3: Female surgeons earn less than male surgeons as they take longer in the operating room to do the same procedures. Therefore, they perform fewer surgeries.

Fact #3: Both female and male surgeons demonstrate equal competence and efficiency in performing surgical procedures. Research indicates that male and female surgeons require the same amount of time to complete common surgical procedures across all specialties. One exception was noted among female plastic surgeons, who took an average of one additional 15-minute increment for common procedures compared to male plastic surgeons. The gender wage discrepancy among surgeons is particularly pronounced in surgical specialities that are predominantly male, including cardiothoracic surgery and ophthalmology.

Female surgeons receive fewer surgical referrals than male surgeons in the same speciality. Some may assume that this imbalance is simply a reflection of a higher proportion of surgeons being male. However, male surgeons received 79.3 per cent of surgical referrals sent by female physicians and 87.1 per cent of referrals sent by male physicians despite only accounting for 77.5 per cent of surgeons in Ontario. Notably, the largest discrepancy in surgical referral patterns between male and female surgeons occurs in obstetrics and gynecology, where male surgeons receive a greater proportion of referrals despite the specialty being predominantly female.

Based on OHIP’s billing codes, procedural work tends to be more lucrative than non-procedural clinical encounters. The observed difference in surgical referrals was not explained by patient traits, surgeon expertise or surgeon availability. Female surgeons tend to receive a higher volume of non-operative referrals than male surgeons. This bias in referral patterns may result in unequal financial opportunities between male and female physicians.

It is evident that the persisting wage gap is influenced by several factors, which may include the systemic impact of implicit gender bias within medical training, hiring processes, remuneration models, and career opportunities. To effectively address this issue on a provincial scale, a comprehensive approach encompassing both upstream and downstream factors is necessary. The fee-for-service payment model is not inherently equitable as it reflects systemic inequities that may result in unequal opportunities for male and female physicians to provide high-revenue services. Further research is also required to explore the persistence of the wage gap beyond the gender binary. Through further research and advocacy efforts, we are hopeful that physician compensation will eventually reflect merit and services rendered.