Pay Gaps in Canadian Medicine

Understanding physician behaviour and its impacts on healthcare delivery is a long-standing topic in health economics, health services and medical research. Physician payment and delivery systems incorporate numerous incentives that have implications for access, service delivery and patient outcomes. This project will contribute much needed empirical evidence on the physician sector, specifically on physician pay gaps related to gender, race/ethnicity, foreign-training and immigration status. We will study all physicians, with a particular focus on the largest specialty group, Family Medicine. While our previous research has addressed aspects of gender gaps in physician pay and labour supply (weeks and hours of work), we will use the theory of intersectionality to recognize how other aspects of social identity such as race and immigration status may intersect with gender to influence earnings. In Ontario, the Ministry of Health and the Ontario Medical Association (OMA) reached a tentative Physician Services Agreement (released March 3, 2022) that sets out a process to initiate steps to close the gender pay gap. In part, this research proposal is interested in informing the implementation of this process, potential similar aspects of Agreements in other provinces, as well as potential extensions. Five distinct data sources providing alternative insights will be employed: Statistics Canada Censuses and Labour Force Surveys, Canada Revenue Agency taxation records, electronic medical records, a survey of physicians, and qualitative data from physicians. Women in the physician workforce appear, on average, to have different approaches to practice than their male colleagues that are only superficially understood. We will examine the sources and ramifications of these differences as well as those due to race/ethnicity, foreign training and immigration status. The initial impact of COVID-19's shock on physician labour supply and earnings gaps will also be explored.