Gender Disparities in Pay Still Problematic for Ob/Gyns

Troy Brown, RN

April 18, 2018

Obstetrician/gynecologists (ob/gyns) who are men reported higher annual compensation ($339,000) than women ($273,000), a difference of $66,000 per year, according to the Medscape Ob/Gyn Compensation Report 2018.

Among all physicians, women were more likely than men to work part-time, however the Medscape survey relied exclusively on full-time salaries, so this does not explain the disparity. And among ob/gyns specifically, differences between men and women were small in terms of rates of part-time (15% vs 14%) and full-time work (85% vs 86%).

A total of 20,329 physicians across 27 specialties responded to the Medscape Physician Compensation Report between November 21, 2017 and February 21, 2018 (men, 66%; women, 34%).

Among ob/gyns, women were the predominant respondents for all racial or ethnic groups compared with men (Asian: 75% vs 25%; African American/black: 61% vs 39%; white: 58% vs 42%), except for Hispanic/Latinos (39% vs 61%).

More women than men were employed among ob/gyns (67% vs 57%). The report authors say these differences may explain some of the income disparities between the sexes.

When the authors looked at how many ob/gyns were trying to get promoted, 36% replied they were and 64% said they were not. Analyzed by sex, 31% of men and 38% of women were aiming for a promotion.

"It's possible that more male doctors already are in leadership positions and female physicians are anxious to catch up," said Tommy Bohannon of Merritt Hawkins, a physician recruitment firm, in the report. "Another factor may be that moving to a full-time or part-time administrative role can lead to greater schedule flexibility and better work-life balance."

Annual Compensation Rose, but Was Below Median

Annual compensation for ob/gyns rose by 5% but was below the median compared with other specialties. Ob/gyns reported annual compensation of $300,000, up from $286,000 in 2017, whereas compensation was highest for plastic surgeons ($510,000) and lowest for public health and preventive medicine specialists ($199,000).

For employed physicians, compensation includes salary, bonus, and profit-sharing contributions. For those who are partners, it includes earnings after taxes and deductible business expenses before income tax.

Most ob/gyns reported being employed (63%) rather than self-employed (33%). This is consistent with national trends indicating hospitals and other organizations have "consolidated and absorbed private practices, and younger physicians have sought a steadier income stream and more regular hours." This trend may have plateaued, the report authors write.

Self-employed ob/gyns reported higher annual compensation ($321,000) compared with employed ob/gyns ($285,000). Working as an employee usually means a steadier income and less time spent on tasks associated with running a business; however, being an employee may not reduce nonclinical workload.

Most ob/gyns received liability coverage and employer-subsidized health insurance, and about two thirds said they also had paid time off and employer-subsidized dental insurance. Fewer ob/gyns said they received vision insurance and employer-matched retirement plans. Only 7% of ob/gyns said they received no benefits.

Compensation Satisfaction and Payment Models

Nearly three fifths (57%) of ob/gyns feel they were fairly compensated, just below the middle for satisfaction among all specialties.

Most (86%) ob/gyns said they were paid through an insurance carrier, and 42% said they were reimbursed on a fee-for-service basis. Other payment models included accountable care organizations (23%), direct payment care (7%), cash-only practice (5%), and concierge practice (1%).

Since the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, numerous changes have been made in the Merit-based Incentive Payment System (MIPS), and more are likely. MIPS and alternative payment models (APMs) are two Quality Payment Programs of the Center for Medicare and Medicaid Services.

Many physicians reported confusion and frustration with the MIPS program and some would like it to be significantly reformed or even replaced. Only 24% of ob/gyns reported participation in MIPS, with only psychiatry having lower participation, at 8%.

Ob/gyns were slightly lower than the middle for participation in APMs, at 8%. Overall participation in APMs is lower than MIPS.

Most (81%) ob/gyns said they would not drop insurers that pay poorly. Of respondents, 25% said they need all payers, 20% said that would be inappropriate, and 36% had other reasons for not dropping poorly paying insurers. Almost one fifth (19%) said they would drop poorly paying insurers.

Most ob/gyns (62%) said they will continue taking new and current Medicare/Medicaid patients; 20% said they have not yet decided.

Almost half (44%) of ob/gyns reported they participate in health insurance exchanges, 19% said they do not, and 37% were unsure. The percentages of ob/gyns who do, or do not, participate in exchanges has plateaued.

Half (52%) of ob/gyns said health insurance exchanges have not caused their income to decrease, 15% said their income had decreased, 4% said their income had increased, and 29% did not participate in exchanges during 2016.

Time Spent With Patients

Of ob/gyns, 9% reported spending fewer than 30 hours/week with patients, while more than half (56%) spent 30–45 hours/week with patients, followed by 46–55 hours/week (18%), 56–64 hours/week (12%), and more than 65 hours/week (4%).

Just 5% spent fewer than 9 minutes with each patient, while 22% spent 9–12 minutes, more than one third (39%) spent 13–16 minutes, 25% spent 17–24 minutes, and 8% spent 25 minutes or longer.

Almost all ob/gyns said they discuss healthcare costs with their patients occasionally (43%) or regularly (47%).

Some physicians are beginning to charge no-show patients for health care visits to avoid overscheduling and keep appointment slots filled. Ob/gyns in solo practices charged for no-shows the most (36%), followed by single-specialty group practices (21%), and multispecialty group practices (4%).

Many Rewards, But Also Challenges

The most rewarding aspects of the job for ob/gyns were gratitude/relationships with patients (33%); knowing they are making the world a better place (25%); being very good at what they do/finding answers, diagnoses (19%); making good money at a job they like (13%); teaching (5%); and being proud of being a physician (4%). Just 1% said there were no rewarding aspects of being an ob/gyn.

The most challenging parts of the job included having so many rules and regulations (19%), working long hours (18%), worrying about being sued (16%), getting fair reimbursement (15%), working with an electronic health record system (14%), and dealing with difficult patients (12%). Only 1% said there were no challenging aspects of the job.

Bureaucratic tasks were a significant cause of burnout for ob/gyns; 32% spend 9 minutes/week or less on paperwork and administration, 43% spend 10–19 minutes/week, and 25% spend 20 minutes/week or more.

Almost three quarters (74%) of ob/gyns said they would choose to practice medicine again, and 75% would choose the same specialty.

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