This episode of the CMAJ Podcast explores how physician identity can influence patient expectations, and how those expectations may contribute to gender, race, and immigration status pay gaps. The discussion builds on the CMAJ article “Family physician pay inequality: a qualitative study exploring how physician responses to perceived patient expectations may explain gender, race, and immigration status pay differences”.

Dr. Monika Dutt, a family physician, public health and preventive medicine specialist, and PhD candidate in health policy at McMaster University, explains how the study’s interviews with 55 family physicians across Ontario revealed patterns linking patient expectations to physician identity. She describes how gender and cultural background influence the types of visits physicians are asked to provide, and how these interactions may affect their earnings under fee-for-service models.

Dr. Meredith Vanstone, professor in the Department of Family Medicine at McMaster University, outlines how physicians adapt to explicit and inferred patient expectations and the income implications that follow. She discusses how these expectations are shaped by identity and why the resulting adjustments in care can lead to financial penalties for some physicians while improving patient relationships and trust.

The guests highlight how remuneration structures can either amplify or mitigate these inequities. They suggest that moving toward salary or time-based models could help reduce the impact of physician identity on income while supporting equitable, patient-centred care.

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