In recent years, the medical profession has increasingly focused on advancing both the quality of patient care and the equity of physician compensation. A groundbreaking study published in the JAMA Health Forum sheds fresh light on the persistent gender wage gap experienced by primary care physicians (PCPs), revealing new dynamics under the evolving Medicare Advantage value-based payment models. This research, led by Dr. Ishani Ganguli, MD, MPH, and Nicholas E. Daley, AB, from Brigham and Women’s Hospital, explores the intricate relationship between physician gender, patient outcomes, and earnings in a rapidly changing healthcare payment landscape.
Traditionally, primary care physicians have been reimbursed through volume-based models—commonly known as fee-for-service—where compensation is tied directly to the number of patient visits or procedures performed. These models tend to incentivize quantity over quality and can inadvertently penalize physicians who invest additional, often uncompensated time in patient care beyond the clinic visit itself. Women PCPs, who studies have repeatedly shown to spend more time with patients and engage more thoroughly in preventive care and care coordination, are therefore disproportionately affected, often realizing lower overall pay despite delivering superior care outcomes.
The Medicare Advantage program, a public-private partnership that now enrolls the majority of Medicare beneficiaries, has embraced value-based payment frameworks designed to reward quality and efficiency over sheer volume. Under these arrangements, physicians receive capitated payments—a flexible amount paid monthly per patient—adjusted for the health status of their patient panel, along with bonuses tied to specific quality metrics. This shift in payment philosophy from volume to value raises critical questions: Does this model reduce traditional gender-based pay disparities? And importantly, does it reflect the nuanced care styles that women physicians bring to primary care?
To address these questions, Ganguli and Daley’s team conducted an in-depth, multi-faceted analysis of data from 2022, encompassing Medicare Advantage claims, quality reporting through Medicare’s Star Ratings, and patient satisfaction scores from NRC Health across 13 different payers. The study focused on 872 PCPs spanning 15 practice groups in seven U.S. states, with women comprising 40% of the physicians examined. This comprehensive dataset enabled the researchers to meticulously control for variations in patient demographics, health status, and practice environment, ensuring a robust comparison between male and female physicians operating within the same group settings.
One of the salient features of their analytic approach was the dual evaluation of physician earnings. First, they calculated per-patient revenue under the traditional volume-based method, summing payments for all primary care services rendered. Second, they assessed net financial performance under full risk value-based contracts by comparing the actual medical spending of each physician’s patients against expected spending benchmarks. This method effectively positioned physician earnings as a function of both care delivery and cost containment—key pillars of value-based care.
Results of the study were revelatory. Patients cared for by women PCPs achieved measurably better outcomes, including improved diabetes management—a notoriously complex and prevalent chronic condition—higher rates of recommended eye examinations, and elevated composite quality scores reflecting a broad spectrum of preventative and chronic care indicators. Moreover, these patients experienced significantly fewer emergency department visits and hospitalizations, signaling not only improved clinical control but also less reliance on costly acute care services.
Despite these clinical advantages, women physicians ultimately received lower patient satisfaction ratings compared to their male counterparts. This finding invites speculation about underlying societal expectations and patient biases that may differentially assess female and male doctors, potentially reflecting greater scrutiny or higher standards placed upon women providers. Such discrepancies pose further challenges to gender equity in medicine, extending beyond financial considerations.
Intriguingly, when payment was assessed under traditional fee-for-service arrangements, women PCPs’ earnings were roughly equivalent to those of their male peers, perpetuating the longstanding narrative of pay parity gaps masked by simplistic aggregate figures. However, the pendulum swung notably when value-based payment was applied. Here, female physicians out-earned men within the same practice groups, a reversal credited to the reduced utilization of expensive acute care services by their patients. This suggests that value-based payment models better capture and reward the holistic, patient-centered care strategies more commonly employed by women providers.
The implications of these findings resonate deeply within healthcare policy and practice management realms. Aligning physician incentives to reward behaviors like comprehensive counseling, extended patient engagement, and diligent care coordination—attributes often more emphasized by women PCPs—could not only promote health equity but also mitigate occupational burnout. Burnout, disproportionately affecting women physicians, contributes to workforce attrition, threatening primary care capacity at a time when the aging U.S. population’s needs are increasing.
By promoting pay equity through value-based models, healthcare systems may see downstream benefits in provider retention and satisfaction, leading to improved continuity of care for vulnerable populations. This study, therefore, underscores the critical importance of payment reform not merely as a financial mechanism but as a catalyst for cultural and systemic change within medicine.
Looking ahead, Dr. Ganguli and colleagues envision expanded research exploring how increased penetration of Medicare Advantage and other value-based contracts across diverse patient panels affects gender-based differentials in earnings and care quality. Such investigations could incorporate longitudinal data to evaluate dynamic shifts as value-based models mature and evolve. Additionally, further exploration is warranted into patient perceptions and provider rating discrepancies to identify actionable strategies to address implicit biases affecting women physicians.
This nuanced examination of gender disparities under emergent payment paradigms provides a vital roadmap for policymakers, healthcare executives, and clinician leaders committed to fostering equitable and effective primary care delivery. As the U.S. healthcare system embarks on a journey toward value-driven care, recognizing and addressing gendered dimensions within this transition will be essential to realizing its full promise.
Dr. Ishani Ganguli and Nicholas E. Daley’s research, funded by the National Institute on Aging, exemplifies the synergy between clinical insight, rigorous data analytics, and health services innovation. By peering beneath aggregate statistics and unearthing the interplay of gender, quality, and compensation, their work challenges prevailing assumptions and highlights new opportunities for reform. As value-based payment frameworks proliferate, embedding gender equity as a core principle will be paramount in shaping a healthcare workforce and system that truly serves all.
Subject of Research: Gender disparities in primary care physician earnings and patient outcomes under Medicare Advantage value-based payment models.
Article Title: Gender Differences in Primary Care Physician Earnings and Outcomes Under Medicare Advantage Value-Based Payment
News Publication Date: 16-May-2025
Web References: https://jamanetwork.com/journals/jama-health-forum/fullarticle/2794263
References: Ganguli, I., Daley, N.E., et al. “Gender Differences in Primary Care Physician Earnings and Outcomes Under Medicare Advantage Value-Based Payment,” JAMA Health Forum, 2025. DOI: 10.1001/jamahealthforum.2025.2001
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