McMaster University Unveils Hidden Factors Behind Gender Pay Gaps in Family Medicine
In a revealing study published in the Canadian Family Physician in January 2026, researchers from McMaster University and the Ontario Medical Association (OMA) have quantified a significant disparity in how male and female family physicians practice in Ontario. The research, titled "Association between family physician gender and patient service times: Evidence from Ontario," highlights that female family physicians (FPs) spend 15% to 20% more time per patient encounter than their male counterparts across most services. This time difference translates into lower earnings under the province's fee-for-service (FFS) model, exacerbating the gender pay gap in Canadian medicine.
The study draws from a cross-sectional survey of 1,055 Ontario FPs, representing a 13.9% response rate from over 10,700 eligible practitioners. Led by Boris Kralj, an adjunct assistant professor in McMaster's Department of Economics and the Centre for Health Economics and Policy Analysis (CHEPA), alongside Lyn Sibley from OMA's Healthcare Evaluative Research (HER), the findings underscore systemic issues in physician compensation. For the most common billing code, intermediate assessment (A007), women averaged 21.4 minutes per visit compared to 17.5 minutes for men—a 3.9-minute (22.3%) gap.
Methodology: Surveying Real-World Practice Patterns
The research utilized self-reported data on service times for the 20 most frequently billed services, which account for 50% of FP payments in Ontario. Respondents rated service intensity on a 5-point scale and provided demographic details like age, immigrant status, ethnicity, and training location. Statistical analysis employed ordinary least squares (OLS) regression with survey weights to adjust for nonresponse, confirming robust differences (P < .001 for most services).
Key demographic insights: Female FPs were younger (46.5 vs. 52.2 years), more likely to have Canadian residencies (92.7% vs. 85.2%), and served more female patients (61.7% vs. 50.4%). The gap was narrower among international medical graduates (IMGs) and non-Canadian residency completers, hinting at cultural or training influences on practice style.
| Service (Fee Code) | Male Mean Time (min) | Female Mean Time (min) | Difference (min/%) |
|---|---|---|---|
| A007 (Intermediate assessment) | 17.5 | 21.4 | 3.9 / 22.3% |
| A001 (Minor assessment) | 8.9 | 10.7 | 1.8 / 20.2% |
| A003 (General assessment) | 30.4 | 36.4 | 6.0 / 19.7% |
| K131 (Periodic health visit adult 18-64) | 26.5 | 31.8 | 5.3 / 20.0% |
This table illustrates select services; similar patterns held for 19 of 20, except Papanicolaou tests (G365).
Quantifying the Earnings Impact: $45,500 Annual Gap
Under Ontario's FFS system, payments tie to billing codes, not duration. Female FPs see fewer patients daily due to longer visits, leading to lower billings. Estimates suggest women must work 2 extra hours daily to match male earnings, equating to a $45,500 yearly shortfall for standard schedules. This aligns with prior data: a 2021 JAMA study reported a 13.5% gap across 30,000+ physicians; a 2022 Health Economics analysis found 9.3% overall (8.5% for family medicine).
A December 2025 JAMA Network Open study linked higher female proportions in specialties like family medicine to lower median payments, with orthopedics showing males earning $1.67 per female dollar. McMaster's work adds granularity, showing structural bias in primary care.
Broad Context: Persistent Gender Disparities in Canadian Medicine
Canada's physician workforce is nearing gender parity (49% female per ICES data), yet gaps persist. OMA's 2020 analysis showed a 15.6% unexplained disparity; CMA notes women earn 16% less in primary care. Factors include specialty choice (women favor lower-paid fields like family medicine, pediatrics), hours worked, and negotiation differences—but McMaster's study reveals time per service as overlooked.
Racialized and immigrant physicians face compounded inequities. A November 2025 CMAJ qualitative study (linked to McMaster themes) found patient preferences drive women and racialized FPs to offer more unbillable services, like counseling. Check professor salaries data for academic medicine parallels.
Patient Expectations and Practice Style Influences
Beyond time, patient biases play a role. Female FPs report spending longer on communication-heavy services (e.g., counseling K013: 32.9 vs. 28.8 min). IMGs show smaller gaps, possibly from efficiency training abroad. This suggests cultural adaptation or patient demographics affect styles—female FPs have more complex panels with higher social needs.
Benefits of longer visits: Better outcomes, trust, accurate diagnoses. Yet FFS prioritizes volume, pressuring shorter encounters.
Provincial Variations and National Implications
Ontario's model mirrors much of Canada, but provinces like BC and Alberta use blended payments. National data from CIHI shows similar trends; CMA advocates equity audits. McMaster's CHEPA expertise positions it as leader in health economics, informing policy via higher ed career advice for medical trainees.
Recent 2025-2026 stats: Female FPs comprise 45% of workforce, yet earn less despite rising numbers.
Stakeholder Perspectives: Calls for Reform
Dr. Lyn Sibley (OMA): "Fee-for-service disadvantages those spending more time." Dr. Kralj: "Amend to include time-based payments." CMA supports transparency; OMA pushes value-based care. Unions like PAIRN advocate mentorship to boost female negotiation.
Read the full McMaster study. CMA's equity hub echoes findings.
Proposed Solutions: Time-Based and Value-Based Models
Recommendations:
- Hybrid billing: Time modifiers for services.
- Value-based payments: Outcomes over volume.
- Transparency: Publish adjusted earnings data.
- Training: Address biases in residency.
- Team models: NPs/PAs share load equitably.
Healthy Debate (2025) proposes value-based to cut gaps; MAP Health calls for audits. Provinces piloting blended pay show promise.
McMaster's Role in Advancing Health Equity Research
McMaster's CHEPA and Family Medicine departments drive evidence-based policy. This study builds on Kralj's prior work (9.3% gap). Explore Rate My Professor for faculty insights or faculty jobs in health economics.
Future Outlook: Toward Pay Equity in Canadian Medicine
With workforce feminization, inaction risks shortages. Projections: Gap closes slowly without reform. McMaster research catalyzes change, urging FFS evolution. Policymakers must act for sustainable primary care. For career guidance, visit higher ed career advice, higher ed jobs, university jobs, Rate My Professor.
