Ishani Ganguli, MD, MPH , and Nicholas E. Daley, AB, of the Department of Medicine at Brigham and Women's Hospital are co-authors of a paper published in JAMA Health Forum, " Gender Differences in Primary Care Physician Earnings and Outcomes Under Medicare Advantage Value-Based Payment ."
Q: How would you summarize your study for a lay audience?
Despite often achieving better patient outcomes, women primary care physicians (PCPs) face a significant and ongoing wage gap compared to their male counterparts. This disparity is partly due to volume-based payment models, where doctors are compensated per visit or service. Women PCPs typically spend additional time caring for patients during and in-between doctor's visits, leading to a greater share of their work going unpaid.
In theory, women physicians may benefit more from newer value-based payment models, where doctors receive flexible monthly payments per patient along with quality bonuses. However, this had not been examined until now.
Our study compared men and women PCPs working in value-based payment models and found that patients with women PCPs had better outcomes for diabetes care and overall, and had fewer emergency department visits and hospitalizations. Through this model, women PCPCs earned more than men PCPs in the same practice groups.
Q: What question were you investigating?
Our team wanted to understand if there are gender differences in care quality and earnings among PCPs participating in full risk-sharing value-based payment arrangements via Medicare Advantage plans, which now enroll most Medicare-eligible adults.
Q: What methods or approach did you use?
We analyzed 2022 Medicare Advantage claims data, Medicare Star quality data, and NRC Health provider rating data from 13 payers. Our study included 872 primary care physicians (PCPs), 40% of whom were women, across 15 practice groups in seven states.
We were primarily interested in the per-patient earnings that PCPs would receive using the volume-based payment approach (calculated as the sum of payments for all primary care services provided) and separately, using the value-based payment approach (that is, earnings or losses calculated by subtracting their patients' actual total medical spending from their expected total medical spending). We also looked at quality measures, health care utilization, and provider rating scores.
We built statistical models that controlled for physician and patient panel characteristics to compare men and women in the same practice groups on these outcomes.
Q: What did you find? When comparing male and female PCPs within the same practice groups, patients of women PCPs had better diabetes control, were more likely to receive eye exams, and achieved higher composite quality scores. They also had fewer emergency department visits and hospitalizations.
However, women PCPs received lower provider rating scores—potentially reflecting higher expectations from patients placed on them.
Women PCPs had similar earnings to men via volume-based payment. Women PCPs earned more than their men colleagues via value-based payment, likely due to their patients having fewer ED visits and hospitalizations.
Q: What are the implications?
The reversal of the gender wage gap under value-based payment implies that this model may be better aligned with desirable practice patterns that are more common in women (e.g., more face-to-face time per visit).
Achieving pay equity could offer benefits beyond fair compensation. It may help reduce burnout—particularly prevalent among women physicians—and improve retention within the increasingly female primary care workforce, ultimately benefiting the aging U.S. population.
Q: What are the next steps?
Future studies could look at how earnings and quality outcomes change as PCPs' panels include larger shares of patients in Medicare Advantage and other value-based payment models.
Paper cited: Ganguli, I., et. Al, "Gender Differences in Primary Care Physician Earnings and Outcomes Under Medicare Advantage Value-Based Payment" JAMA Health Forum DOI: 10.1001/jamahealthforum.2025.2001
Funding: This work was supported by grants from the National Institute on Aging (K23AG068240).
Disclosures: Ganguli reported consulting fees from F-Prime outside the submitted work. Victoria DiGennaro reported grants from Herself Health Medical Advisory Board, stock in agilon health, and personal fees as Pioneer Physicians Network owner/chief executive officer outside the submitted work. Benjamin Kornitzer and Lauren Polt were employed by agilon health during the conduct of the study. No other disclosures were reported.
