UBC Theses and Dissertations
Beyond full-time equivalents : gender differences in activity and practice patterns for BC's primary care physicians Hedden, Lindsay Kathleen
There is widespread sentiment that British Columbia (BC) is facing a substantial shortage and a maldistribution of primary care physicians (PCPs). The increasing proportion of PCPs who are women has been cited as contributing to this complex problem, based largely on assumptions that female physicians work less, take time off to raise children, and retire earlier compared to their male counterparts. However, Canadian evidence supporting these assertions is lacking. This thesis uses population-based, administrative data resources to undertake a comprehensive assessment of the potential impact of the increasing feminization of BC’s PCP workforce, focusing on gender differences in career trajectories, billing patterns, activity, patient and service mix, and scopes of practice. It consists of four components: a systematic review of existing literature; a longitudinal analysis of gender-specific remuneration and activity; a comparison of patient populations seen by male and female PCPs; and an examination of gender-driven differences in selected aspects of primary care practice. The results of these analyses suggest that female PCPs have lower total remuneration, see fewer patients, and deliver fewer services annually compared to male PCPs; however, this gender-related activity gap is narrowing over time as male physicians are reducing their activity levels. Female physicians derive more of their income from direct clinical care delivery (rather than from clinical or non-clinical incentive payments) when compared to male physicians. The proportion of physicians’ total compensation derived from direct care delivery is declining, particularly for male physicians. Results also show that female physicians have smaller overall practices and disproportionately treat younger, healthier patients. They are less likely to provide off-site and after-hours care, but more likely to include obstetrical care in their practices. This thesis demonstrates that gender differences in primary care practice go beyond salary and service volumes. More robust measures of physician supply that address the implications of gender differences in patient mix, service mix, and practice style need to be developed as more evidence in these areas becomes available. The gender division of unpaid care work, household responsibilities, and work-life balance, and the implications for health human resource planning all deserve careful attention in future work.
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