Association between family physician gender and patient service times: Evidence from Ontario.

OBJECTIVE: To quantify differences between self-reported service times of male and female family physicians (FPs) in Ontario. DESIGN: Cross-sectional census survey of FPs in active practice and survey weights for nonresponse. SETTING: Ontario. PARTICIPANTS: A total of 1055 FPs practising in Ontario who completed the survey. MAIN OUTCOME MEASURES: Self-reported duration, in minutes, of the services Ontario FPs most commonly provide. RESULTS: For 19 of the 20 services examined, female FPs reported longer average service times than those of their male colleagues. Female-male differences ranging from 15% to 20% were statistically significant and clinically relevant. For the most frequently billed service, the intermediate assessment (bill code A007), female FPs spent an average of 3.9 minutes (22.3%) longer per service than male FPs (P<.001). The Papanicolaou test (bill code G365) was the only service for which the reported service times were the same for both male and female FPs. Gender differences were less pronounced among international medical graduates and those who completed their residency outside of Canada, suggesting that training background influences service time. CONCLUSION: Female FPs in Ontario reported spending more time per patient than their male colleagues across a range of services, with the association attenuated for those with non-Canadian medical degrees or residencies. Current payment models do not account for time spent, thereby potentially structurally disadvantaging female physicians in terms of overall earnings. The gender pay gap in family practice could be reduced if current fee structures were replaced by, or amended to include, time-based payments.