Disparities in Physician Compensation by Gender in Ontario, Canada

Key Points Question Do male and female physicians in Ontario, Canada, receive equal payments for equal work? Findings In this cross-sectional study including 31 481 physicians (nearly all physicians in Ontario), women earned 32.8% less than men annually and 22.5% less daily. After controlling for observable factors associated with earnings, such as practice characteristics, geography (degree of rurality), and specialty, the daily pay gap remained significant, at 13.5%. Meaning This cross-sectional study describes a complex set of factors associated with payment disparities affecting female physicians, considering both daily and annual payment gaps and the variations by specialty, rurality, and practice settings.
This cross-sectional study examines differences in pay by gender among physicians in Ontario, Canada.
Importance Men and women should earn equal pay for equal work. An examination of the magnitude of pay disparities could inform strategies for remediation. Objective To examine gender-based differences in pay within a large, comprehensive physician population practicing within a variety of payment systems. Design, Setting, and Participants This cross-sectional study used data from the Ontario Health Insurance Plan (OHIP) in the 2017 to 2018 fiscal year to estimate differences in gross payments between men and women physicians in Ontario, Canada. Pay gaps were calculated annually and daily. Regression analyses were used to control for observable practice characteristics that could account for individual differences in daily pay. In Canada’s largest province, Ontario, medical services are predominantly provided by self-employed physicians who bill the province’s single payer, OHIP. All physicians who submitted claims to OHIP were included. Data were analyzed from January 2020 to July 2021. Exposures Physician gender, obtained from the OHIP Corporate Provider Database. Gender is recorded as male or female. Main Outcomes and Measures Gross clinical payments were tabulated for individual physicians on a daily and annual basis in conjunction with each physician’s practice characteristics, setting, and specialty. Results A total of 31 481 physicians were included in the study sample (12 604 [40.0%] women; 18 877 [60.0%] men; mean [SD] time since graduation, 23.3 [13.6] years), representing 99% of active physicians in Ontario. The unadjusted differences in clinical payments between male and female physicians were 32.8% (95% CI, 30.8%-34.6%) annually and 22.5% (95% CI, 21.2%-23.8%) daily. After accounting for practice characteristics, region, and specialty, the overall daily payment gap was 13.5% (95% CI, 12.3%-14.8%). The pay gap persisted with differing magnitudes when examined by specialty (ranging from 6.6% to 37.6%), practice setting (8.3% to 17.2%), payment model (13.4% to 22.8% for family medicine; 8.0% to 11.6% for other specialties), and rurality (8.0% to 16.5%). Conclusions and Relevance This cross-sectional study examined differences in magnitude of annual and daily payment gaps and between unadjusted and adjusted gaps. Comparing the gaps for different specialties, geography, and payment systems illustrated the complexity of the issue by showing that the pay gap varied for physicians in different practice settings. As such, multiple directed interventions will be necessary to ensure that all physicians are paid equally for equal work, regardless of gender.