How physician identity influences income

Nov 17, 2025

Guest

Meredith Vanstone

Guest

Monika Dutt

Dr. Monika Dutt, a family physician and PhD candidate, and Dr. Meredith Vanstone, a Family Medicine professor, discuss how physician identity can influence patient expectations and resulting pay disparities. They reveal insights from interviews with diverse family physicians, highlighting how gender and cultural backgrounds shape care dynamics. The conversation explores the implications of financial models, emphasizing that moving towards salary-based structures could alleviate income inequities linked to identity-driven care.

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INSIGHT

Persistent Pay Gaps Despite Standard Fees

Large datasets show persistent pay gaps by gender, race, and immigration status among physicians.
These gaps persist despite medicine's standardized fee schedules, suggesting hidden mechanisms drive inequality.

ANECDOTE

Patients Request Physicians By Identity

Patients sometimes call and explicitly request physicians by gender or language for specific concerns like birth control.
Physicians also frequently infer expectations based on past encounters and patient needs.

INSIGHT

Gendered Workloads Affect Earnings

Gendered expectations channel more pelvic procedures and longer emotionally focused visits toward women physicians.
Those visit types can be lower-paid or time-consuming under fee-for-service, reducing income for those physicians.

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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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