The gender-based physician compensation gap is more than a workplace injustice – it undermines the efficiency and effectiveness of the Canadian health-care system.
This gap limits access to care and exposes the shortcomings of current fee-for-service (FFS) reforms. We propose value-based care as a practical and transformative solution, capable of reducing pay disparities while tackling the current issues faced by our health-care system.
The compensation gap manifests in multiple ways: within-specialty pay discrepancies (female physicians making less than male physicians in the same specialty), between-specialty payment differences (differences in compensation between male-predominant and female-predominant specialties for similar work), and patient-specific variation in reimbursement (differences in compensation for services provided to female compared with male patients).
This compensation gap decreases access to high-quality health care and access in numerous ways by contributing to: 1) the gender-based gap in physician burnout, 2) hindering physician representation in low-paying specialties, 3) disincentivizing patient-centred care practices, and 4) promoting medical mistrust.
Poor compensation, along with gender bias and discrimination, has been closely linked to higher rates of burnout among female physicians. Research involving more than 13,000 health-care providers found that 57 per cent of female providers reported at least one symptom of burnout, compared to 47 per cent of male providers. Only 44 per cent of female providers felt valued within their organization, versus 52 per cent of males. These differences may contribute to reduced work hours and early retirement among female providers, undermining workforce stability.
Primary care, where females make up a larger share of the workforce, is especially at risk. The compensation gap contributes to a gender-based disparity in physician burnout, which in turn impacts retention, worsens workforce shortages and increases wait times. This ultimately decreases access to health care and contributes to the physician shortage crisis in Canada.
The gender-based physician compensation gap can influence medical students’ specialty choices. Students from low-income and racial and ethnic minority backgrounds are more likely to carry significant educational debt and often feel financial pressure to pursue higher-paying specialties. As a result, lower-paying fields such as primary care, which are both female-dominated and essential to health-care access, may struggle to attract individuals from a wide range of socioeconomic and cultural backgrounds.
This lack of varied representation within the physician workforce can negatively impact health-care quality, as research consistently shows that a broader mix of perspectives and lived experiences among physicians is linked to better clinical outcomes, innovation, financial performance, patient satisfaction and trust, cultural competency and improved access to care for underserved populations.
The gender-based physician compensation gap discourages patient-centred care, which is associated with better health outcomes and cost-effectiveness. Female physicians are more likely to provide this type of care, emphasizing respect, responsiveness to patient values and shared decision-making, but these practices often involve longer patient interactions and may lead to lower earnings.
The gender-based physician compensation gap discourages patient-centred care.
The compensation gap may contribute to medical mistrust, particularly among marginalized groups, ultimately leading to poorer health outcomes. Awareness that female physicians and procedures related to female patients are valued less financially can erode patient trust and may cause patients to delay seeking care, underutilize health services, or not adhere to treatment –factors that contribute to delayed diagnoses, poorer clinical outcomes and higher health-care costs.
Current policy reforms aim to make FFS compensation fairer by adjusting the value of billing codes for male and female anatomic procedures based on technical complexity. These reforms include using relative valuation methods to identify pay discrepancies, standardizing fees based on factors like procedure duration and technical skill and implementing a national system to identify undervalued billing codes with transparency. However, while such reforms may help narrow the gender-based compensation gap, they fall short of addressing the devaluation of feminized work embedded within the FFS model and remain focused on the volume of services provided rather than health-care outcomes.
Current FFS reforms aim to address pay gaps but overlook how the model itself devalues “feminized” specialties. As specialties become female-dominated, they often see declines in prestige and compensation – a reflection of broader labour patterns in which “feminized” work, such as teaching and nursing, is socially and economically devalued. The FFS model reinforces this by prioritizing procedures over cognitive, time-intensive and relational care, which are traditional hallmarks of female-dominated jobs. As a result, female-dominated fields like family medicine, pediatrics, psychiatry and public health are undervalued.
Furthermore, the FFS model’s emphasis on service volume over health outcomes not only undervalues time-intensive, patient-centred practices, but also actively discourages team-based care and patient education since it rewards brief, frequent visits over comprehensive, coordinated care.
Ultimately, adjusting billing codes is only a temporary fix. We propose adopting a value-based care model that not only reduces the gender-based compensation gap but also addresses the broader challenges facing the Canadian health-care system, including high costs, physician burnout and shortages and poor health outcomes.
The value-based care model includes payment methods such as pay-for-performance, where providers receive bonuses or penalties based on quality benchmarks; shared savings and risk models, which reward providers for reducing costs while maintaining care quality; and capitation, which offers fixed payments per patient regardless of service volume. By emphasizing patient outcomes, these models recognize the value of patient-centred care often delivered by female physicians, helping to narrow the gender-based compensation gap while improving health outcomes.
For example, a United States study of 872 primary care physicians under Medicare Advantage found that patients of female physicians had better clinical outcomes, including improved hemoglobin A1c control and fewer emergency visits and hospitalizations. This translated into higher earnings for female physicians through value-based care model payments. Moreover, value-based models reduce physician burnout, with research showing lower burnout rates among primary care physicians who receive at least 75 per cent of their income from such models, thereby supporting better retention and attracting more medical students to primary care. Value-based payment models also lower health-care costs. For instance, physician groups participating in Medicare’s Shared Savings Program achieved net savings of $256.4 million by reducing spending.
Nonetheless, value-based care is not without its flaws. Some value-based payment models, like certain capitation models, fail to address the gender-based compensation gap. Additionally, some models do not demonstrate significant differences in outcomes or costs compared to FFS models. Nevertheless, Canada has the opportunity to learn from the successes and failures of other jurisdictions. By tailoring a value-based care model to meet its specific needs, Canada can enhance health-care access, improve outcomes and elevate the experiences of patients and providers alike.
