• Ishani Ganguli, Kathleen L Mulligan, Robert L Phillips, and Sanjay Basu.
• Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts (I.G.).
• Ann. Intern. Med. 2022 Aug 1; 175 (8): 113511421135-1142.

BackgroundThe physician gender wage gap may be due, in part, to productivity-based compensation models that undervalue female practice patterns.ObjectiveTo determine how primary care physician (PCP) compensation by gender differs when applying existing productivity-based and alternative compensation models.DesignMicrosimulation.Setting2016 to 2019 national clinical registry of 1222 primary care practices.ParticipantsMale and female PCPs matched on specialty, years since medical school graduation, practice site, and sessions worked.MeasurementsNet annual, full-time-equivalent compensation for male versus female PCPs, under productivity-based fee-for-service, panel size-based capitation without or with risk adjustment, and hybrid payment models. Microsimulation inputs included patient and visit characteristics and overhead expenses.ResultsAmong 1435 matched male (n = 881) and female (n = 554) PCPs, female PCP panels included patients who were, on average, younger, had lower diagnosis-based risk scores, were more often female, and were more often uninsured or insured by Medicaid rather than by Medicare. Under productivity-based payment, female PCPs earned a median of $58 829 (interquartile range [IQR], $39 553 to $120 353; 21%) less than male PCPs. This gap was similar under capitation ($58 723 [IQR, $42 141 to $140 192]). It was larger under capitation risk-adjusted for age alone ($74 695 [IQR, $42 884 to $152 423]), for diagnosis-based scores alone ($114 792 [IQR, $49 080 to $215 326] and $89 974 [IQR, $26 175 to $173 760]), and for age-, sex-, and diagnosis-based scores ($83 438 [IQR, $28 927 to $129 414] and $66 195 [IQR, $11 899 to $96 566]). The gap was smaller and nonsignificant under capitation risk-adjusted for age and sex ($36 631 [IQR, $12 743 to $73 898]).LimitationPanel attribution based on office visits.ConclusionThe gender wage gap varied by compensation model, with capitation risk-adjusted for patient age and sex resulting in a smaller gap. Future models might better align with primary care effort and outcomes.Primary Funding SourceNone.

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