Feature
What’s behind the gender pay gap in general practice?
The issue is now well-known, but GPs say little progress has been made.
Dr Caroline Johnson believes everyone needs to care about inequality of pay within our profession.
There’s no doubt we’ve woken up to the ubiquity of the gender pay gap.
Which means if you think GPs aren’t affected by this, you’re wrong, says Sydney GP Dr Elizabeth Oliver, who wrote a story in the Sydney Morning Herald about this exact issue.
She points out that, according to the Workplace Gender Equality Agency, female doctors earn less than their male counterparts, per hour, across almost all specialties, and after correcting for hours worked.
‘I make between 12 and 25% less per hour than my typical male colleague,’ she writes.
‘Data from the Family Medicine Research Centre at the University of Sydney also shows that I’m likely to manage more issues and complexity per consultation, address social issues that affect health, prescribe less medication, and spend more time on preventive care and, as a result, I see my patients less frequently.’
GP and senior lecturer in general practice at the University of Melbourne, Dr Caroline Johnson, applauds Dr Oliver for shining a light on this critical issue.
However, while she’s keen to discuss gender pay issues, Dr Johnson told newsGP it would be a ‘great shame’ if having these conversations led to conflict between male and female doctors.
‘Because all genders need to care about inequality of pay within our profession,’ she said.
‘Better remuneration for longer consultations, less item numbers that can be gamed for financial advantage and more financial reward for doing work that addresses known population health needs, like mental health, would be worth considering.’
Dr Oliver’s opinion piece notes that ‘not all male doctors’ are less-caring than their female colleagues, saying many are ‘compassionate, thorough and generous’. Yet, she says male GPs tend to be ‘lauded’ for such traits above females, ‘because this emotional labour is often taken for granted when women supply it’.
Dr Johnson agrees with Dr Oliver’s comments about the different ways female GPs work, specifically ‘the different types of patients who come to see us and possibly also the different expectations people have about what a female doctor offers that might differ from a male’.
There is an argument that men are less likely to take time off to raise children and more likely to put in longer hours as a ‘breadwinner’ as a father, therefore contributing to the disparity between a female and male GP’s income.
Research from 2016 found that Australian females GPs with children earned around $30,000 less than comparable female GPs without children, while male GPs with children earned at least $45,000 more than comparable GPs without children.
However, an article by Dr Grace Fitzgerald in Level Medicine notes, ‘a large part of the pay gap is unexplained’.
‘Importantly, the pay gap in medicine cannot simply be explained by differences in the way male and female doctors work,’ Fitzgerald wrote.
‘Between a quarter and a half of the earnings gap between male and female GPs in Australia is not attributable to hours worked, career interruptions or employment type.’
So we do we explain the difference?
According to Dr Oliver, it may be the type of care provided by female GPs and the kind of issues they see.
‘In a country where preventive and mental health have become the most powerful determinants of wellbeing, rather than rampant infectious disease or obstetric danger, the “social stuff” is becoming increasingly critical to effective general practice,’ she wrote.
‘If you want to do good medicine – save lives, improve quality of life, keep Medicare sustainable – you have to do this work.’
And doing that work may well mean seeing less patients per hour.
This was the basis of a furore created last year when a patient noted a sign at her general practice clinic in North Eltham, where patients were charged more to see a female rather than a male GP.
Surgeon Dr Neela Janakiramanan addressed this issue in Women’s Agenda last year, explaining that the female GPs in question chose to see four patients per hour, while their male colleagues saw six an hour.
‘So while the fee for a female GP appears higher, those GPs still earn $1000 less a day than their male colleagues,’ she wrote.
Dr Janakiramanan said that, when surveyed, patients tend to see female doctors for more complex problems.
Chair of the RACGP Antenatal/Postnatal Care Specific Interests network Dr Wendy Burton told newsGP the length of consultation plays a role in the well-documented gender pay gap.
‘The longer any GP spends in any consultation, the less we earn. This has been known for a long time,’ she said
Dr Burton pointed to BEACH data that identifies female GPs spend more time with patients, on average, than their male counterparts. She also said research shows that female GPs cover an average of 1.63 problems per encounter, while male GPs average 1.51.
Not only do female GPs spend longer with their patients, Dr Janakiramanan says such patients are then often more likely to discuss their financial struggles and be bulk billed as a result, leading again to a further decrease in pay for female doctors.
The issue of bulk billing and its effect on pay is one Dr Johnson is familiar with.
‘Many patients have stuck with me because I am prepared to bulk bill them due to my good understanding of the social disadvantage that contributed to their health issues in the first place,’ she said.
‘That’s my choice, of course. It’s great that I can make a secure, if not extravagant, income and feel I am making a difference where it matters most.
‘I hope many male and female GPs feel this way too and we should all work together to ensure remuneration is in proportion to the benefit it brings with respect to patient outcomes.’
Meanwhile, Dr Burton hopes to see the gender pay gap abolished by creating a level playing field for all clinicians.
‘I would like to see the high value which is placed on relationship building, mental health, complex care and the like when researchers and politicians are talking, [be] supported by adequate and appropriate funding across the sectors and in a way that is gender neutral.’
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