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Female physicians in Ontario earn less on average than male physicians in 35 specialties, including those dominated by female doctors, such as obstetrics and gynecology

Female doctors in Ontario made less on average than their male counterparts in 35 medical specialties tracked by the Ministry of Health, a Globe and Mail analysis of physician billings has shown.

This was true even in specialties such as obstetrics and gynecology, where the majority of practising doctors were women.

The most male-dominated disciplines were also the ones that paid the best. Based on the average compensation within each specialty, male doctors dramatically outnumbered female physicians in all 10 of the most highly remunerated areas of practice.

Meanwhile, female-dominated specialties were both rare and among the least lucrative. Overall, women outnumbered men in only six of the 35 disciplines and half of those female-dominated specialties fell among the 10 lowest paid. The constant was that women made less money.

This is the power gap: Explore the investigative series and data

This in-depth analysis of the gender divide within specific medical specialties, which is part of The Globe’s ongoing Power Gap investigation into gender inequities in the work force, is based on Ontario Health Insurance Plan (OHIP) billing information for the 2020 to 2021 billing period, which The Globe obtained through a freedom of information request.

In addition to examining the overall wage and representation gaps within practice areas, The Globe divided each specialty into salary bands. Through this lens, a consistent trend appeared: women were concentrated in the lower-paid echelons, while men dominated the top bands.

In Canada, most doctors operate as small businesses, and invoice the government directly in a fee-for-service model. This is what OHIP billings represent.

Until recently, those numbers were secret in Ontario. This changed three years ago, after a protracted court battle launched by the Toronto Star over a rejected freedom of information request. The newspaper had asked for a list of the top 100 OHIP billers and were refused. In 2019, the Supreme Court of Canada declined to hear an appeal request from the Ontario Medical Association and other groups to keep the information secret. Shortly after, the OHIP numbers were released to the newspaper.

A similar situation played out in Newfoundland and Labrador. The CBC had filed an access request in that province in 2016, which was also refused. It too went to court, but after the OHIP decision, the Newfoundland and Labrador Medical Association dropped its efforts to block the information’s release. (British Columbia has disclosed fee-for-service billings for years and today, most provinces make the data available.)

The Globe used the precedent set by the Star’s request for the top 100 billers to obtain the OHIP billings for all 32,158 Ontario doctors who invoiced for services. Doctors who billed less than $10,000 were removed from The Globe’s analysis, which affected 3,368 people. There were 37 specialties in all, but The Globe excluded “community medicine” from the analysis, because only eight doctors identified it as a specialty, six of whom billed less than $60,000. Were community medicine to be included, this is the lone discipline in which women out-earned men.

The gender divide among the most and least lucrative medical specialties

The Globe and Mail analyzed the gender wage and representation gaps within Ontario's 36 medical specialties. Generally, disciplines that were heavily male-dominated were the best paid, while specialties with larger numbers of female physicians were among the least well remunerated

Men

Women

Wage gap (how much women

make less than men)

TEN HIGHEST-PAID SPECIALTIES

Average income by gender

Specialty (headcount)

0

200

400

600

$800K

Ophthalmology

Wage gap:

-31%

$484K

$699

(398)

Diagnostic radiology

-25

663

498

(1,038)

Cardiology

-40

615

368

(653

Neurosurgery

-48

591

305

(89)

Gastroenterology

-18

555

453

(260)

Nephrology

-26

561

413

(193)

Cardiothoracic surgery

-17

501

415

(83)

Vascular surgery

-42

491

284

(76)

Thoracic surgery

-24

463

350

(44)

TEN LOWEST-PAID SPECIALTIES

Urology

-42

436

254

(273)

Physical medicine

-27

266

194

(199)

Infectious disease

-9

229

209

(143)

Psychiatry

-25

246

184

(1,727)

Paediatrics

-36

278

179

(1,047)

Geriatrics

-40

284

169

(118)

Emergency medicine

-39

238

146

(228)

Haematology

-26

233

172

(132)

Medical oncology

-37

192

120

(46)

Genetics

-70

162

49

(23)

Pathology, micro-

biology, clinical

biochemistry (158)

-26

71

53

MAHIMA SINGH, CHEN WANG AND MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: PHYSICIAN ONTARIO HEALTH INSURANCE PLAN (OHIP) BILLINGS FOR THE PERIOD OF APRIL 2020 TO MARCH 2021 WERE OBTAINED THROUGH A FREEDOM OF INFORMATION REQUEST TO THE MINISTRY OF HEALTH. DOCTORS WHO BILLED LESS THAN $10,000 WERE EXCLUDED FROM THE ANALYSIS. A TOTAL OF 37 SPECIALTIES WERE REPRESENTED IN THE DATA, BUT THE GLOBE DID NOT INCLUDE FAMILY DOCTORS IN THE ANALYSIS BECAUSE MANY ARE NOT COMPENSATED THROUGH OHIP'S FEE-FOR-SERVICE MODEL. THE "COMMUNITY SPECIALTY" WAS ALSO REMOVED BECAUSE ONLY PHYSICIANS IDENTIFIED IT AS A PRIMARY PRACTICE AREA. THE GLOBE DETERMINED THE GENDER OF PHYSICIANS USING A DATASET PROVIDED BY STATISTICS CANADA ON THE GENDER PROBABILITY OF FIRST NAMES. ONLY NAMES THAT WERE ASSOCIATED WITH A SPECIFIC GENDER AT LEAST 95 PER CENT OF THE TIME WERE INCLUDED. THE GLOBE MANUALLY RESEARCHED THE GENDER OF MORE THAN 2,000 PHYSICIANS TO RESOLVE AREAS OF VOLATILITY WITHIN SPECIFIC SALARY BANDS. THE GENDER OF ABOUT 1,600 PHYSICIANS WERE NOT RESEARCHED, BECAUSE THEIR PRESENCE DID NOT HAVE AN IMPACT ON THE FINDINGS. FOR EXAMPLE, IF THERE WERE 50 PHYSICIANS IN A SALARY BAND, AND THE GENDER OF 47 WAS KNOWN, THE OUTSTANDING THREE DID NOT IMPACT THE PERCENTAGES. THESE PHYSICIANS ARE NOT INCLUDED IN THE ABOVE HEADCOUNT TOTALS.

The gender divide among the most and least lucrative medical specialties

The Globe and Mail analyzed the gender wage and representation gaps within Ontario's 36 medical specialties. Generally, disciplines that were heavily male-dominated were the best paid, while specialties with larger numbers of female physicians were among the least well remunerated

Men

Women

Wage gap (how much women make less than men)

TEN HIGHEST-PAID SPECIALTIES

Average income by gender

Specialty (headcount)

0

200

400

600

$800K

Ophthalmology

Wage gap:

-31%

$699K

$484K

(398)

Diagnostic radiology

-25

663

498

(1,038)

Cardiology

-40

615

368

(653

Neurosurgery

-48

591

305

(89)

Gastroenterology

-18

555

453

(260)

Nephrology

-26

561

413

(193)

Cardiothoracic surgery

-17

501

415

(83)

Vascular surgery

-42

491

284

(76)

Thoracic surgery

-24

463

350

(44)

TEN LOWEST-PAID SPECIALTIES

Urology

-42

436

254

(273)

Physical medicine

-27

266

194

(199)

Infectious disease

-9

229

209

(143)

Psychiatry

-25

246

184

(1,727)

Paediatrics

-36

278

179

(1,047)

Geriatrics

-40

284

169

(118)

Emergency medicine

-39

238

146

(228)

Haematology

-26

233

172

(132)

Medical oncology

-37

192

120

(46)

Genetics

-70

162

49

(23)

Pathology, micro-

biology, clinical

biochemistry (158)

-26

71

53

MAHIMA SINGH, CHEN WANG AND MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: PHYSICIAN ONTARIO HEALTH INSURANCE PLAN (OHIP) BILLINGS FOR THE PERIOD OF APRIL 2020 TO MARCH 2021 WERE OBTAINED THROUGH A FREEDOM OF INFORMATION REQUEST TO THE MINISTRY OF HEALTH. DOCTORS WHO BILLED LESS THAN $10,000 WERE EXCLUDED FROM THE ANALYSIS. A TOTAL OF 37 SPECIALTIES WERE REPRESENTED IN THE DATA, BUT THE GLOBE DID NOT INCLUDE FAMILY DOCTORS IN THE ANALYSIS BECAUSE MANY ARE NOT COMPENSATED THROUGH OHIP'S FEE-FOR-SERVICE MODEL. THE "COMMUNITY SPECIALTY" WAS ALSO REMOVED BECAUSE ONLY PHYSICIANS IDENTIFIED IT AS A PRIMARY PRACTICE AREA. THE GLOBE DETERMINED THE GENDER OF PHYSICIANS USING A DATASET PROVIDED BY STATISTICS CANADA ON THE GENDER PROBABILITY OF FIRST NAMES. ONLY NAMES THAT WERE ASSOCIATED WITH A SPECIFIC GENDER AT LEAST 95 PER CENT OF THE TIME WERE INCLUDED. THE GLOBE MANUALLY RESEARCHED THE GENDER OF MORE THAN 2,000 PHYSICIANS TO RESOLVE AREAS OF VOLATILITY WITHIN SPECIFIC SALARY BANDS. THE GENDER OF ABOUT 1,600 PHYSICIANS WERE NOT RESEARCHED, BECAUSE THEIR PRESENCE DID NOT HAVE AN IMPACT ON THE FINDINGS. FOR EXAMPLE, IF THERE WERE 50 PHYSICIANS IN A SALARY BAND, AND THE GENDER OF 47 WAS KNOWN, THE OUTSTANDING THREE DID NOT IMPACT THE PERCENTAGES. THESE PHYSICIANS ARE NOT INCLUDED IN THE ABOVE HEADCOUNT TOTALS.

The gender divide among the most and least lucrative medical specialties

The Globe and Mail analyzed the gender wage and representation gaps within Ontario's 36 medical specialties. Generally, disciplines that were heavily male-dominated were the best paid, while specialties with larger numbers of female physicians were among the least well remunerated

Men

Women

Wage gap (how much women make less than men)

TEN HIGHEST-PAID SPECIALTIES

Average income by gender

Specialty (headcount)

Wage gap

Gender breakdown

0

200

400

600

$800K

Ophthalmology

22%

78%

$699K

$484K

-31%

(398)

Diagnostic radiology

27

73

663

498

-25

(1,038)

Cardiology

20

80

615

368

-40

(653

Neurosurgery

13

87

591

-48

305

(89)

Gastroenterology

27

73

555

-18

453

(260)

Nephrology

30

70

561

-26

413

(193)

Cardiothoracic surgery

13

87

501

415

-17

(83)

Vascular surgery

13

87

491

-42

284

(76)

Thoracic surgery

18

82

463

-24

350

(44)

TEN LOWEST-PAID SPECIALTIES

Urology

10

90

436

-42

254

(273)

Physical medicine

36

64

266

-27

194

(199)

Infectious disease

36

64

229

-9

209

(143)

Psychiatry

45

55

246

-25

184

(1,727)

Paediatrics

61

39

278

-36

179

(1,047)

Geriatrics

64

36

284

-40

169

(118)

Emergency medicine

29

71

238

146

-39

(228)

Haematology

45

55

233

-26

172

(132)

Medical oncology

41

59

192

120

-37

(46)

Genetics

13

87

162

-70

49

(23)

Pathology, microbiology,

clinical biochemistry (158)

45

55

71

53

-26

MAHIMA SINGH, CHEN WANG AND MURAT YÜKSELIR / THE GLOBE AND MAIL, SOURCE: PHYSICIAN ONTARIO HEALTH INSURANCE PLAN (OHIP) BILLINGS FOR THE PERIOD OF APRIL 2020 TO MARCH 2021 WERE OBTAINED THROUGH A FREEDOM OF INFORMATION REQUEST TO THE MINISTRY OF HEALTH. DOCTORS WHO BILLED LESS THAN $10,000 WERE EXCLUDED FROM THE ANALYSIS. A TOTAL OF 37 SPECIALTIES WERE REPRESENTED IN THE DATA, BUT THE GLOBE DID NOT INCLUDE FAMILY DOCTORS IN THE ANALYSIS BECAUSE MANY ARE NOT COMPENSATED THROUGH OHIP'S FEE-FOR-SERVICE MODEL. THE "COMMUNITY SPECIALTY" WAS ALSO REMOVED BECAUSE ONLY PHYSICIANS IDENTIFIED IT AS A PRIMARY PRACTICE AREA. THE GLOBE DETERMINED THE GENDER OF PHYSICIANS USING A DATASET PROVIDED BY STATISTICS CANADA ON THE GENDER PROBABILITY OF FIRST NAMES. ONLY NAMES THAT WERE ASSOCIATED WITH A SPECIFIC GENDER AT LEAST 95 PER CENT OF THE TIME WERE INCLUDED. THE GLOBE MANUALLY RESEARCHED THE GENDER OF MORE THAN 2,000 PHYSICIANS TO RESOLVE AREAS OF VOLATILITY WITHIN SPECIFIC SALARY BANDS. THE GENDER OF ABOUT 1,600 PHYSICIANS WERE NOT RESEARCHED, BECAUSE THEIR PRESENCE DID NOT HAVE AN IMPACT ON THE FINDINGS. FOR EXAMPLE, IF THERE WERE 50 PHYSICIANS IN A SALARY BAND, AND THE GENDER OF 47 WAS KNOWN, THE OUTSTANDING THREE DID NOT IMPACT THE PERCENTAGES. THESE PHYSICIANS ARE NOT INCLUDED IN THE ABOVE HEADCOUNT TOTALS.

The Globe also removed doctors in the “family practice and general practice” specialty because it is common for family doctors to work outside of the fee-for-service system. For example, many use the capitation model, which involves a fixed payment per patient. This is not reflected in OHIP billings, although many family doctors still do some fee-for-service work.

Based on OHIP billings alone, the wage gap in family medicine was 37 per cent and women represented 45 per cent of doctors. About half of all Ontario physicians included in the dataset are listed as family doctors.

Some physicians practice multiple specialties. In the data provided to The Globe by the ministry, physicians were categorized by the specialty in which more than half of their billings were submitted.

In total, physicians working in 35 specialties were analyzed, just over a third of whom were women. Among these physicians – regardless of specialty – the overall gender wage gap was 34 per cent, with male doctors earning an average of $405,814 and women $265,983.

Last year, the OMA published its own study of the gender gap in medicine using 2017-2018 OHIP billings, which identified an annual gap of 32.8 per cent. After controlling for factors such as geography and specialty, the OMA says an unexplained gap of 13.5 per cent remained.

OHIP billings do not necessarily reflect a physician’s income, as they don’t account for doctors’ expenses, such as rent, equipment and staff.

The OHIP billing data did not include the gender of each physician, but The Globe determined this by using a dataset on the gender probability of first names, which Statistics Canada provided for the Power Gap series at a cost of $6,000. About 90 per cent of first names in Canada are associated with a particular gender at least 95 per cent of the time.

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The Globe manually researched the gender of more than 2,000 physicians to resolve areas of volatility. It was not possible to consider the divide between racialized and white physicians, because names are not a reliable indicator of race. It was also not possible to evaluate the compensation of gender-diverse doctors.

Michelle Cohen, a family doctor in Ontario who researches the gender pay gap in medicine, said the gender gaps in medicine have been well-established by numerous studies, but there are still those who push back.

“One of the first things you’re going to hear as a criticism is: this is fee-for-service. You do a service, you bill a code and you get the money. It seems fair … but there is built-in bias,” Dr. Cohen said.

For example, Dr. Cohen’s research has found that certain procedures – particularly those performed on female bodies – pay less. In a 2020 paper that Dr. Cohen co-authored with Tara Kiran, they noted that a surgeon in Ontario is paid $50.90 for an incision under general anesthetic on a vulvar abscess, but $99 for a scrotal abscess. And a biopsy on a penis paid $39.60, but one on the vulva paid $26.85.

One enduring myth, said Dr. Kiran, is that the wage gap can be explained by the fact that men tend to work longer hours. It’s true that male physicians do work longer hours, but not enough to account for the gap. A British Columbia study that looked at primary-care physicians in 2017 found that women made 36 per cent less than men, but worked just three hours less per week.

Women are also pushed into less lucrative specialties and recent research has shown they are less likely to receive surgical referrals, she said.

Finally, women also tend to take more time with patients but a fee-for-service model means one billing code per visit, no matter the length.

Said Dr. Cohen: “So let’s say I’m spending 30 minutes with a patient, providing many services – emotional and psychological support – a high-volume colleague could see three people and provide less service in that time. It looks like they’re doing more work, but they’re not.”

A detailed breakdown of the gender divide within each specialty, by wage gap, representation gap and at different salary bands, is available on The Globe’s website.

Editor’s note: An earlier version of this article included an incorrect photo caption. This version has been corrected.

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