But despite the growing prevalence of female practitioners in rheumatology and healthcare as a whole, compensation models remain mostly tied to RVUs and other measures of productivity. That connection works against female rheumatologists, who typically work fewer hours than their male counterparts. Information from the 2015 State Physician Workforce Data Book published by the Centers for Workforce Studies reported that female physicians worked seven hours less a week and treated 30% fewer patients on average than their male counterparts.2
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“I would flip the question on its head and say, we do need to provide care to the most numbers [of patients], but we also want to provide quality care,” Dr. Bass says. “The question is: Is it better to see patients every 10 or 15 minutes, or is it better to talk to them a little bit longer and see fewer patients per hour? I think a lot of women would argue that quality of care is more important, especially in fields in which you’re managing patients over the long haul.”
Dr. Bass says more female doctors, as well as younger doctors, expect a better work–life balance when entering the field, which is a major reason why the 2015 Workforce Study projects lower clinical full-time equivalents (FTEs) over the coming years. The field needs to examine a holistic approach to compensation moving forward, she adds. That approach would include paying for services that don’t directly generate revenue, as well as tying in quality and safety measures.
“Reimbursement strictly on an RVU basis, especially in academic centers, doesn’t necessarily give credit or value to a lot of other aspects of work physicians do that are valuable to the healthcare system and to patients,” she says. “Spending more time talking to a patient is valuable. Spending more time teaching residents and doing other non-remunerated things is also valuable. And those activities tend not to be valued or paid for in academic centers.”
Dr. Bass adds that, despite gains in gender equality in society as a whole, many male physicians have a support system at home that allows them to work more hours.
“If you have a model based on what men do—[one in which] women typically are responsible for taking care of the kids at home, etc.—if there’s that [established] model, then women will never achieve the kind of productivity targets that are set based on a man’s structured work life,” Dr. Bass says. “So if society decides that [it wants] equity, [it has] to acknowledge that somebody has got to be there picking up the kids and getting home at an earlier hour … A lot of the men who work long hours have a wife who can be at home.”