Value-based care and gender pay gap

A new study published in *JAMA Health Forum* reveals a surprising trend: under value-based care payment models, women doctors are earning more per patient than their male counterparts. Traditionally, women physicians have faced a persistent gender wage gap due to a focus on volume rather than quality of care. This study, examining data from physicians working under full-risk Medicare Advantage contracts, demonstrates that when payment is tied to patient health and cost management, the qualities and behaviors often exhibited by women doctors – such as increased patient interaction and follow-up – become valuable assets. This finding suggests a path towards a fairer healthcare system that recognizes and rewards the comprehensive care provided by women physicians.

Read the full article at https://www.paperleap.com/blog/articles/how-value-based-care-might-close-the-gender-pay-gap-0cccuw

Episode Transcript

Speaker 1 (00:00):
Welcome to the paper Leap podcast, where a science takes
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(00:21):
Don't forget to subscribe so you never miss an insight.
All the content is also available on paper leap dot com. Okay, ready,
let's start. For decades, studies have told the same story.
Women doctors, despite delivering excellent care, consistently earn less than
their male colleagues. The gap isn't small. It adds up

(00:44):
to millions of dollars over a physician's career. A new
study published in JAMA Health Forum seems to add a
twist to the narrative. Under certain payment systems, that gender
wage gap doesn't just shrink, it reverses. Medicine has long
struggled with gender pay inequity. Even in fields where women

(01:04):
now make up a large share of the workforce, they
still earn less For primary care physicians, the doctors who
serve as the first stop for most patients. The difference
can be stark. One widely cited estimate found that over
a forty year career, female physicians earn about two million
dollars less than their male counterparts. Part of the answer

(01:27):
lies in how doctors are typically paid. In traditional fee
for service models, physicians bill for each visit or procedure.
That system tends to reward quick high volume care. Research
shows women doctors often spend more time with each patient
and devote additional hours outside the exam room to follow up,

(01:48):
charting and coordination of care. These important but less visible
efforts don't always translate into higher billing. The result is
that women provide more of the invisible glue that holds
patient care together, yet their paychecks lag behind. In recent years,
a new approach to physician payment has gained traction, value

(02:09):
based care. Instead of rewarding doctors solely for the number
of visits, value based models pay physicians based on how
healthy their patients are and how well the doctors manage costs.
It works under Medicare advantage, a form of private Medicare insurance,
and some primary care physicians agree to take full financial

(02:29):
responsibility for their patient's medical spending. They receive a fixed
risk adjusted monthly payment for each patient. If their patients
stay healthier and avoid expensive hospital stays, the doctors and
their organizations can come out ahead financially. If patients need
more costly care, the practice shoulders the loss. This system

(02:51):
flips the incentive structure Quality, not quantity, drive success. As
this new study suggests, it may also hold hold the
key to closing the gender wage gap in medicine. The
researchers behind the study looked at data from eight hundred
and seventy two primary care physicians across seven states who
were working under full risk Medicare advantage contracts. These doctors

(03:15):
cared for more than two hundred and twenty three thousand patients.
The researchers compared male and female doctors on several fronts,
including earnings from both traditional FIFA service and value based payments,
quality of care measured by Medicare's Star ratings, including things
like diabetes management and preventative screenings, patient outcomes such as

(03:38):
emergency department visits and hospitalizations, and patient ratings, that is,
how patients scored their doctors in satisfaction surveys. By analyzing
the data, the researchers discovered four interesting facts. First, in
terms of quality of care, patients of women doctors had
slightly better outcomes. They were more likely to have good

(03:59):
diat beat's control, to get their recommended eye exams and
to hit overall quality benchmarks. Second, these patients also went
to the emergency department and hospital less often. Third, when
it comes to earnings, there is the big headline. Under
FIFA service, men and women earned about the same, but
under value based care, women doctors actually earned more per

(04:22):
patient than men. And finally, as far as patient ratings
are concerned, despite delivering equal or better outcomes, women doctors
received lower satisfaction scores from patients, a reminder of persistent
gender bias in perceptions of care. So why did women
do better under value based care? The researchers suggest it

(04:44):
comes down to alignment. Women doctors, on average spend more
time per visit and engage more deeply in follow up
and coordination of care. Those behaviors may not rack up
billable visits under FIFA service, but they pay off in
the value based world by by keeping patients healthier and
out of the hospital. Value based care finally rewards the

(05:06):
kind of medicine women physicians have often practiced all along.
This study has significant implications for fairness and equity. Pay
Equity is not just about money, it's about recognition and respect.
If women consistently deliver excellent care, they deserve to be
compensated accordingly. Also, there are consequences in terms of burnout

(05:27):
and retention. Primary care is grueling work, and burnout is common.
Equal pay may reduce stress and help retain more physicians,
especially women in the workforce. That's crucial as America's population
ages and demand for primary care skyrockets. And finally, this
study adds weight to arguments for expanding value based payment models.

(05:49):
If the system can both improve patient outcomes and correct
gender based inequities, that's a powerful case for change. In summary, picture,
two doctors working in the same clinic. Doctor Smith, a
man sees as many patients as possible in short visits.
Doctor Johnson, a woman spends extra minutes listening to her

(06:09):
patient's concerns and follows up with phone calls in the evening.
Under fee for service, doctor Smith might take home a
bigger paycheck because he can bill for more visits. Under
value based care, doctor Johnson's patients stay healthier and avoid
costly hospital visits, meaning her practice earns more. That's the
real world difference this study highlights. It's not about women

(06:31):
working harder, it's about systems that finally reward the kind
of thorough, patient centered care that many women already provide. Indeed,
no single study is definitive, especially on such contentious topics.
The authors note a few caveats. The physicians in this
study voluntarily chose full risk contracts, so they may not

(06:52):
represent all doctors. The data focused on Medicare advantage patients,
who are mostly older adults. The study looked at practice earnings,
not individual take home pay, though comparing doctors within the
same groups helps reduce this concern. Still, the finding suggests
that as more of the healthcare system shifts to value
based care, the gender pay gap could shrink or even disappear.

(07:16):
Future studies will need to track what happens as these
models expand. The takeaway is both hopeful and practical payment
systems matter. When we design healthcare models that reward quality
instead of speed, we not only improve patient care, but
also take a meaningful step toward gender equity. That's it

(07:39):
for this episode of the Paper Leap podcast. If you
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