The Ontario Medical Association (OMA) said it cannot explain the reasons why, but an in-depth study revealed there is a pay gap of more than 15 per cent between male and female doctors.
The 30 page study, reported to be the largest study of its kind in Canada, was released by the OMA in August and is the result of examining OHIP billings from 2017 and 2018. The study was initiated in May of 2019.
The association said the study included billings "from nearly all doctors practising in Ontario and adjusted for certain factors, such as years of experience and work outside of business hours, to create an apples-to-apples comparison."
The executive summary outlined the basic findings:
"This work found that, on average, male physicians bill 15.6 per cent more than their female counterparts, after controlling for available practice characteristics and labour market inputs. Substantial variation in the billings gap was observed across Assembly, geography, payment model and practice setting. The differences observed among physician groups are central to understanding how to combat pay inequities."
The report also said the concept of pay inequity is well-known and well-researched, but "little is understood about the drivers of earnings inequity in medicine, particularly in Ontario. As the medical profession becomes increasingly gender balanced, the issue of remunerative equity has become an issue of increasing concern to physicians."
The report further revealed that in terms of inequity, physicians are unique because most do not earn a wage or salary. In most cases, physicians will invoice for the services provided, sending their bills to the Ontario Health Insurance Plan (OHIP).
The report said payments to physicians are made at a flat rate regardless of age, gender, or other physician characteristics and circumstances.
"However, large differences in billings across gender lines are difficult to ignore. It is possible that structural issues, sociological factors and discrimination may be driving a gap in gross clinical payments (a billing gap) and, therefore, a disparity in earnings," said the report.
The report also revealed the unexplained gap was the highest among general and family practice physicians at 19 per cent and lowest among surgeons at 10.2 per cent. The gap was highest in a semi-urban setting (19.8 per cent), and lowest in rural settings (10.1 per cent) with urban landing in the middle (13.5 per cent).
“The gender pay gap is an unfortunate reality that crosses all sectors,” said OMA CEO Allan O’Dette. “With this report we can start to address how it impacts physicians. Hopefully, this work will lead to better equity not only for doctors but for all women.”
There were also limitations for the study, the report said.
"We were unable to identify overhead expenses or hours worked, making a net income gap comparison infeasible,” said the report. “Instead, we constructed a comparison of average daily public billings, while controlling for available productive characteristics."
It was also revealed that private income (income from non-OHIP funded services) was not available for study; thus provision of private services may have implications for gender pay disparities that cannot be observed. Also, clinical income was not always attributable to individual physicians.
Another observation in the report was “that female physicians may be streamed into lower billing specialties and subspecialties through their training pathways. No data were available to us on the training journey of medical students and residents. As a result, our exploration of whether female physicians tend to select the lower billing specialties was examined only superficially. These estimates do not address gender differences in training selection," said the report.
The study concluded with four key recommendations:
- The OMA should take a lead role in revising the OHIP schedule of benefits to better reflect the work required for each service and any changes should be done through a "gender lens" to ensure all physicians get equal advantage.
- The OMA should launch an equity advocacy campaign to raise awareness of promoting fair and equitable career advancement and equal pay for equal work policies.
- The OMA advocates expanding opportunities for female physicians and medical learners in such areas as leadership development, networking, mentorship and career planning.
- The OMA should advocate for better employment benefits and support associated with other professionals, and that improved parental benefits to lessen the financial burden associated with having families.
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