Latent gender inequalities in the well-being of physicians according to payment method for practicing medicine: a cross-sectional study

Abstract

Background: Female physicians face extra challenges in their career development and tend to choose salary or other forms of alternative payment plans (APP). Fee-for-service (FFS) and APP may affect the well-being of female and male physicians differently. Three measures of well-being are: levels of career satisfaction, professional equity, and daily distress. The objectives are to identify differences in the levels of career satisfaction, fulfillment-recognition equity, and daily distress of physicians by gender and payment method, and to assess interactions between these two factors. Methods:A cross-sectional study was conducted in 2011 with physicians practicing in the Saskatoon Health Region, Saskatchewan, Canada. Resident physicians were excluded from the study. Eligible physicians completed a survey, assessing levels of daily distress, fulfillment-recognition equity, and career satisfaction as dependent variables. A multivariate analysis of variance (MANOVA), using the Wilks' Lambda criterion, was conducted to study differences among the dependent variables by remuneration method and gender. Multiple comparisons were performed as post-hoc tests.Results: Nearly half (382) of the 794 eligible physicians completed the questionnaire; 37.2% were female. Half were remunerated by FFS, a quarter by APP, and the remainder by blended forms. Career satisfaction and fulfillmentrecognition equity were positively correlated to each other and daily distress was negatively correlated with both. According to the MANOVA results, the dependent variables were affected by gender but not by payment method, and there was no evidence of an interaction effect between payment method and gender. Women reported lower levels of career satisfaction (p=0.01) and fulfillment-recognition equity (p=0.01), and higher levels of daily distress (p=0.03). Conclusion:Female physicians reported poorer well-being than male physicians. In contrast, no differences in the well-being were found among physicians paid by APP, blended methods, and FFS schemes. Further cross-national studies are recommended to study potential effects of APP on the identified gender inequalities.

Factors Associated with Satisfaction of Hospital Physicians: A Systematic Review on European Data

“…Intrinsic factors refer to the inherent characteristics of the medical profession, for example patient interactions, demographics and complexity, as well as their own specialty [ 1 ]. Still, some personal and contextual factors are understudied and require further attention [ 7 , 8 , 10 , 11 ].…”

Payment method as a predictor of daily distress experienced by physicians

“…As our results identified in the multivariable analysis, payment method is a significant predictor of distress perceived by physicians when other predictors and confounding variables are considered in the assessment of this association. Gender [31,32] , time devoted to academic [9,33] and administrative duties [9] , and total number of working hours [34] are significant factors and they should be incorporated in distress models. Physicians self-select a payment method [35] and when they are paid by non-FFS schemes they tend to distribute their time differently [36] .…”

“…Regular working hours/week were found to confound the coefficients of payment method and proportion of complex patients; time devoted to academic duties confounded the coefficients of payment method; and time dedicated to administrative tasks confounded the coefficients of age group and payment method. Along with gender [31,32] , regular working hours/week, time devoted to academic duties, and time dedicated to administrative tasks were added to obtain an adjusted model with ten predictors (AIC = 806.97). Afterwards, interactions between predictors of distress and payment methods were tested.…”