In a groundbreaking study published in the Canadian Medical Association Journal, researchers have uncovered a complex interplay between physician identity, patient expectations, and income disparities among family physicians in Ontario, Canada. This qualitative research elucidates how variations in perceived patient demands and physician responses based on gender, race, and immigration status may contribute significantly to persistent inequities in physician pay within the same specialties.
The study, conducted by McMaster University researchers, involved in-depth interviews with 55 family physicians practicing in Ontario. By analyzing these rich qualitative data, the researchers shed light on the nuanced ways in which physicians’ identities shape their clinical interactions and, consequently, their earnings. Despite standardized fee schedules ostensibly ensuring equitable pay, the findings reveal that income disparities endure, shaped in part by how doctors navigate patient expectations influenced by social identity markers.
At the core of this phenomenon lies the perception of different patient expectations depending on the gender of their physicians. Female physicians reported feeling pressured to dedicate more time per consultation, providing extensive emotional support and attentive listening. This increased appointment duration, while likely enhancing patient satisfaction and care quality, paradoxically reduces the volume of billable encounters they can conduct, thereby impacting overall compensation adversely.
The gendered nature of medical care was particularly apparent in domains related to reproductive health and sensitive examinations. Patients frequently preferred physicians of the same gender for procedures such as pelvic exams, intrauterine device (IUD) insertions, pregnancy care, menopause management, as well as erectile and prostate examinations. These services often attract lower fees within standardized payment structures, disproportionally affecting specialties and physicians who predominantly provide such care, which tend to be women.
Racialized and immigrant physicians face additional unique challenges that compound these disparities. The study highlights how patients often seek clinicians from shared cultural or linguistic backgrounds, which, while fostering patient-physician rapport, may require these physicians to extend appointment times for cultural mediation, education, and advocacy. Such responsibilities, though critical for equitable care delivery and addressing systemic barriers, curtail the total number of patients seen, impacting workload and remuneration.
Another critical insight concerns how racialized physicians encounter situations necessitating extra effort to address misconceptions or to advocate for their patients within the healthcare system. This advocacy role is seldom remunerated under current fee-for-service models, yet it demands valuable physician time and resources. Consequently, this invisible labor contributes silently to the economic disparities observed across different physician groups.
The study’s findings reveal that these dynamics transcend individual practice styles and reflect broader systemic issues rooted in healthcare compensation models. Fee-for-service schedules do not account for the qualitative differences in consultation time, emotional labor, or advocacy burden, factors that are disproportionately borne by women, racialized, and immigrant physicians. Such disparities thus perpetuate inequities in pay despite comparable qualifications and hours worked.
From a policy perspective, the study advocates for reevaluating compensation frameworks to better capture and remunerate the multifaceted nature of contemporary primary care. Adjusting fee schedules to recognize longer and more complex patient interactions could mitigate the financial penalties associated with gendered and culturally nuanced care provision. Ensuring fair compensation for services primarily related to female anatomy is another urgent reform, addressing underpayment for clinical procedures like cervical cancer screening and IUD insertions.
Moreover, the authors emphasize that these findings carry implications for workforce planning and the structuring of team-based care models. By acknowledging and leveraging physician diversity—including cultural and linguistic competencies—health systems can optimize patient outcomes while promoting equity among healthcare providers. Such organizational strategies could redistribute workload more equitably and acknowledge the added labor certain physicians undertake.
Despite highlighting challenges, the study acknowledges that physician responsiveness to patient expectations often enhances patient satisfaction and care quality. The willingness of physicians to adapt practice behaviors reflects professional commitment and ethical responsiveness, suggesting that achieving income equity should not compromise patient-centered care but rather support it through better-aligned compensation schemes.
In conclusion, this research adds compelling evidence to the dialogue surrounding physician pay equity in Canada by situating income disparities within the context of identity-based patient expectations and physician labor responses. It challenges policymakers and healthcare administrators to reconceptualize compensation models to reflect the diverse realities of clinical practice and address documented pay gaps systematically.
By providing a detailed qualitative exploration, this study fills a critical research gap, moving beyond simplistic comparisons of hours worked to examine the substantive content of physician work through the lens of social identity. Such nuanced understanding is key for fostering a more equitable, effective, and inclusive healthcare workforce.
As the medical landscape in Canada shifts towards greater diversity among practicing physicians, addressing these inequities becomes imperative not only for fairness but also for sustaining high-quality patient care and maintaining physician morale and retention. This pioneering investigation thus offers timely and actionable insights, urging an urgent reassessment of pay structures consonant with the evolving demographics and ethical imperatives of modern medical practice.
Subject of Research: People
Article Title: Family physician pay inequality: a qualitative study exploring how physician responses to perceived patient expectations may explain gender, race, and immigration status pay differences
News Publication Date: 17-Nov-2025
Web References:
https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250665
http://dx.doi.org/10.1503/cmaj.250665
Keywords: Doctor patient relationship; Health care delivery; Health equity; Health disparity; Medical economics; Family medicine
