What’s behind the gender pay gap in general practice?

Evelyn Lewin

10/07/2019 4:14:40 PM

The issue is now well-known, but GPs say little progress has been made.

Dr Caroline Johnson
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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Dr Mark Frederick Fletcher   11/07/2019 7:22:45 AM

There is no gender pay gap. Your decrease in your earnings is your choice. You also don't work as hard, don't see as many patients and take more time off and are more likely to work part-time. It's got nothing to do with a pay gap.

Dr Craig Andrew Morris   11/07/2019 10:36:16 AM

If we a contemplating solutions with an end point of "income equity" then we need to contemplate the model we use and it is nice to tie that to a measured outcome (ie show the model offers value for money).

As observed , my female colleagues might generally counsel and see more mental health .

In our current "fee for service" model , it is greatly distressing that the mental health planning items were eroded over time and that the current 2713 (cons C item with mental health component), now pays less than a con c - 36.

I'd start by suggesting that we try to not make things worse by diminishing the gazetted value mental health engagements and at least encourage higher rebates for these activities again.

Defend mental health engagements right here and now and look for broader solutions.

John B Dixon   11/07/2019 11:04:35 AM

The GP pay gap is huge. But your on the page. It’s the feminisation of general practise that has lowered the pay for all. It has moved the realm of nursing and teaching. How else can you explain the freeze on rebates. GPs need to act together to address this.

Dr Gillian Anne Riley   11/07/2019 11:10:27 AM

The evidence points to the fact that being more likely to work part time is not a gender issue its an age issue as in newer doctors regardless of gender tend to work part time.

The evidence shows that female doctors see less patients because they tend to do more in their consultations, ie they work harder for the patients they do see.

And the evidence clearly shows that a gender pay gap does exist.

it's disappointing to see the first comment be so poorly evidenced based from someone who purports to be a colleague and has clearly never read any of the science behind this which is widely available. We are supposed to be a science based profession. Its no small wonder we women doctors feel so up against it sometimes.

Dr Kate Frances Douglas   11/07/2019 8:51:55 PM

Thank you Gillian Riley, I was just about to write a similarly outraged response re the first comment.

Dr Evan Wayne Ackermann   11/07/2019 9:20:03 PM

Yes there is a pay gap Gillian - but the evidence pointing to why is both incomplete and subject to interpretation. I would welcome your input at shareGP.

V   11/07/2019 9:26:22 PM

A deeply disappointing and sexist article imo. I fear that if we want to see medicine go the way elite college campuses/journalism and politics have over the last 3 yrs then continue this narrative... If we want to see men ultimately silenced and leaving the profession then once again, continue this narrative... there aren't separate contracts and fee structures for men compared to women, a 23/36/44 etc is same despite being a man or a woman or a medical Ewok . the choices each clinician makes is theirs to own. people should stop externalising their personal choices. equal opportunity not equal outcomes (see JB Peterson for further details). and by the way who here measures their sense of self worth by their income anyway??

Paul Jenkinson   11/07/2019 10:41:56 PM

As long as female doctors see themselves as “victims” of a system they have no hope of “equity”(in this case ,financial equity)
They have equal opportunity to earn more money than men if they choose to charge what they consider themselves to be worth.
Take the initiative and charge realistic fees or continue to choose to earn less money by maintaining the status quo.
It would be great for the profession ,men and women,if they chose the former.

Dr Mark Frederick Fletcher   11/07/2019 10:57:53 PM

If you think you are working harder for your patients, why aren't you charging for it? You are on the same percentage as your male colleagues. This idea that women do more for their patients is total rubbish. Everywhere I've worked, I've had to pick up the slack for the slow female doctors. Evidence? Show me the randomised control trial that shows women work harder for each patient. I bet you can't. it's all emotion based. I bet these are observational studies. Or surveys. I may as well survey the house cat. Ask yourself this question, do so see more than 160+ patients a week? Cos, if you don't it means you don't work as hard as me. Do you mostly bulk bill? If you do, it means you don't value the work you do yourself and would rather rich tax-payers like me to pay for it. That's the reality. Stop shoving this left wing garbage down our throats. My generation has had enough.

Andrew   12/07/2019 4:08:31 PM

I always feel extremely aggrieved by this constant perception that I am less thorough and/or doing a lesser job than colleagues.. male as well, but mostly female...because I run on time and see more patients during the working day. This longer style of consultation can only exist where there are other GPs in the Practice who can, and do, pick up the slack. Any body reviewing my notes will see that problems are dealt with appropriately, opportunistic health promotion covered and my clinical notes detailed. Patient surveys confirm a very high level of satisfaction with my clinical practice.

ANGELA NIMMO   12/07/2019 7:15:45 PM

some very inflammatory comments from some male colleagues!However also some truths. But seeing more patients per day does not necessarily equate with working harder. Long consultations and counselling are very draining. It is about charging an appropriate fee and working smarter. I have never felt that I have earned less than male colleagues .

Willem Thiart   13/07/2019 8:42:09 PM

The highest earner in our practice is female and she work less hours than me. The pay gap is entirely a personal choice.

Dr Seamus   14/07/2019 7:31:05 PM

Plainly, there is no gender descriptor with Medicare billing numbers.

Warren   16/07/2019 8:33:52 AM

Time for some myth busting:
- There is no separate MBS item number does not discriminate on the grounds of gender
- I have never seen an employment or sole-trader contract that offers less income based on a gender divide
- Female GPs are free to charge what they deem their service is worth. If they don't charge appropriately, they have only themselves to blame
- The number of days or hours a female GP works is entirely in her control.
- There are plenty of female GPs who earn more than male GPs, especially those who run short efficient consultations, or perform procedural work, or charge well for their services etc. A famous inspiring example is the founder of a large social media group for doctors.

It's completely inappropriate to play victim on behalf of all female GPs and claim sexism. Start charging patients appropriately for your services, or you risk undervaluing not just yourselves, but the profession as a whole.

anonymous female GP   24/07/2019 7:47:49 PM

As a female GP who earns as much or more than her male colleagues, I agree with several of our male colleagues comments as well as a couple of my female colleagues comments.
Charging appropriately for the excellent service we provide is something that we should all be doing. Using the stalled Medicare rebate as a yardstick for payment for the services we provide is absurd and yet we continue to use it.
It is possible for both male and female GP's to deal with many complex cases in routine 15 minute appointments, isn't that what most of us do every day?. At times with less complex cases, 10 minutes is plenty when we are experienced at what we do.
I do not think it is remotely helpful to shout down any of our colleagues and agree completely with Paul, Mark, Andrew and Warren.
Our greatest benefit as GP's is having the flexibility to choose our work hours, our style of practice, how efficient we use our time and time off to support friends and family. How we bill is also our choice.