Practice composition and sex differences in physician income: observational studyBMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2588 (Published 30 July 2020) Cite this as: BMJ 2020;370:m2588
- Christopher M Whaley, policy researcher1,
- Daniel R Arnold, postdoctoral fellow2,
- Nate Gross, chief medical officer3,
- Anupam B Jena, Ruth L Newhouse associate professor4 5 6
- 1Rand, Santa Monica, CA, USA
- 2Department of Health Policy and Management, University of California, Berkeley, Berkeley, CA, USA
- 3Doximity, San Francisco, CA, USA
- 4Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
- 5Massachusetts General Hospital, Boston, MA, USA
- 6National Bureau of Economic Research, Cambridge, MA, USA
- Correspondence to: A B Jena @AnupamBJena on Twitter) (or
- Accepted 1 June 2020
Objective To assess whether differences in income between male and female physicians vary according to the sex composition of physician practices.
Design Retrospective observational study.
Setting US national survey of physician salaries, 2014-18.
Participants 18 802 physicians from 9848 group practices (categorized according to proportion of male physicians ≤50%, >50-75%, >75-90%, and >90%).
Main outcome measures Sex differences in physician income in relation to the sex composition of physician practices after multivariable adjustment for physician specialty, years of experience, hours worked, measures of clinical workload, practice type, and geography.
Results Among 11 490 non-surgical specialists, the absolute adjusted sex difference in annual income (men versus women) was $36 604 (£29 663; €32 621) (95% confidence interval $24 903 to $48 306; 11.7% relative difference) for practices with 50% or less of male physicians compared with $91 669 ($56 587 to $126 571; 19.9% relative difference) for practices with at least 90% of male physicians (P=0.03 for difference). Similar findings were observed among surgical specialists (n=3483), with absolute adjusted sex difference in annual income of $46 503 ($42 198 to $135 205; 10.2% relative difference) for practices with 50% or less of male physicians compared with $149 460 ($86 040 to $212 880; 26.9% relative difference) for practices with at least 90% of male physicians (P=0.06 for difference). Among primary care physicians (n=3829), sex differences in income were not related to the proportion of male physicians in a practice.
Conclusions Among both non-surgical and surgical specialists, sex differences in income were largest in practices with the highest proportion of male physicians, even after detailed adjustment for factors that might explain sex differences in income.
Contributors: All authors contributed to the design and conduct of the study, data collection and management, analysis and interpretation of the data; and preparation, review, or approval of the manuscript. ABJ supervised the study and is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding: ABJ was supported by the Office of the Director, National Institutes of Health (1DP5OD017897), CMW was supported by the National Institutes on Aging (1K01AG061274), and DRA was supported by the Nicholas C Petris Center on Health Care Markets and Consumer Welfare. The research conducted was independent of any involvement from the sponsors of the study. The study sponsors were not involved in study design, data interpretation, writing, or the decision to submit the article for publication.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: external funding support from the National Institutes on Aging (1K01AG061274) to CMW, the Nicholas C Petris Center on Health Care Markets and Consumer Welfare to DRA, and the Office of the Director, National Institutes of Health (1DP5OD017897) to ABJ; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work; ABJ reports receiving consulting fees unrelated to this work from Pfizer, Hill Rom Services, Bristol Myers Squibb, Novartis, Amgen, Eli Lilly, Vertex Pharmaceuticals, AstraZeneca, Celgene, Tesaro, Sanofi Aventis, Biogen, Precision Health Economics, and Analysis Group; CMW reports consulting fees unrelated to this paper from Doximity; DRA reports consulting fees unrelated to this paper from the Rhode Island Department of Health; NG reports being employed by and holding stock in Doximity.
Ethical approval: This study was approved by the institutional review boards at Harvard Medical School and at Rand.
Data sharing: No additional data available.
ABJ affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies are disclosed.
Dissemination to participants and related patient and public communities: The results of this work will be disseminated to the public through institutional press release, ensuing news articles, and an opinion piece authored by the study’s authors that describe the study’s findings for the public.
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