People upset about this sign charging a 'premium' for female doctors should be more concerned about why female GPs earn less

People upset about this sign charging a ‘premium’ for female doctors should be more concerned about why female GPs earn less

Twitter and conventional media are abuzz today about a Melbourne practice that apparently charges a ‘premium’ for female doctors: $7 more per standard consultation in fact.

Surgeon Neela Janakiramanan responds to the outrage. 

A gender pay gap is likely to exist at the Victorian clinic with the above sign, as it does all over Australia, and it is not a matter of women getting paid more.

There is a documented and well discussed gender pay gap in medicine. The gender pay gap is maximal in surgical specialties, being as high as 50%, and this is after seniority (medicine is bottom heavy in women) and hours worked (women, even doctors, still bear the burden of childrearing) are taken into account. There are a multitude of well studied and well documented reasons for this, but primary among them is that female doctors, at a statistical level, offer longer consultation times than men.

Patients, when surveyed, tend to see female doctors for more complex problems – and, at the end of it, are more likely to discuss their financial difficulties AND subsequently be bulk billed as a consequence. Female procedural specialists tend to be referred complex non-procedural problems because of the perception that women are better communicators while the “simple” procedures are sent to male specialists.

Again, these complex patients are more likely to have financial issues and be bulk billed. Resulting in persistent gender pay gaps in medicine, even though women increasingly have the seniority and do the hours of our male colleagues.

It is worth mentioning that this extra time results in tangible and measurable benefits, with studies showing that the patients of female GPs are less likely to be admitted to hospital, and a landmark BMJ study involving thousands of patients showing that female surgeons have fewer complications and deaths.

So back to this clinic, we come to Medicare, and the Medicare item number 23, which is a standard consultation by a specialist GP lasting less than 20 minutes.

GPs can choose to schedule patients in blocks of time, and the two options tend to be to schedule either six patients an hour, or four. This, for those not mathematically inclined, means that consultation of both ten minutes and fifteen minutes are covered by the same item number, despite the 15 minute appointment being 50% longer – and resulting in 16 patients less being seen in an eight hour working day.

At this particular clinic, in recognition of the fact that they often do see more complex patients, it is my understanding that the female GPs all elected to book four patients an hour – and the male GPs all decided to book six patients an hour. So while the fee for a female GP appears higher, those GPs still earn $1000 less a day than their male colleagues, and are now being vilified for it.

Terrible sign, but good medicine for less pay.

With state and national ministers up in arms about this sign at one GP clinic in one suburb – despite the fact that the national data regarding higher fees and income by male doctors has been around for decades – perhaps now they will look into into the gender pay gap in medicine and investigating why these female GPs still earn less, not more.

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