Study Reveals Impact of Patient Expectations on Physician Income

A recent study published in the Canadian Medical Association Journal reveals that physician responses to patient expectations significantly influence their income. Conducted by researchers from McMaster University, the qualitative study highlights income disparities among physicians in Canada, particularly affecting women, racialized, and immigrant practitioners.

The research involved interviews with 55 family physicians in Ontario, aiming to understand the reasons behind persistent income differences related to identity. According to Dr. Meredith Vanstone, a professor in the Department of Family Medicine and Canada Research Chair in Ethical Complexity in Primary Care, “Pay disparities related to gender, race, and immigration status persist among Canadian physicians, even within specialties and after adjusting for hours worked.”

These disparities are particularly notable in family medicine, where physicians typically receive standardized payments through fee schedules. The study indicates that the way physicians perceive and respond to patient expectations may contribute to these income gaps. Dr. Vanstone elaborates, stating, “Physicians respond to perceived patient expectations by adjusting their practice and behavior, including the way they interact, the length of an appointment, and the services they provide. These are decisions that may ultimately impact income.”

As the number of women and international medical graduates in Canadian healthcare continues to rise, understanding and addressing income inequalities is crucial. The findings are especially relevant as incomes in medical specialties with a higher proportion of women physicians have been declining relative to other specialties.

In the study, the authors point out that “providing longer, more comprehensive patient interactions limits the number of appointments or services that physicians can provide.” This situation can create financial disadvantages for women whose compensation models depend on roster size or patient volume.

To mitigate these pay disparities, the authors suggest that compensation models should account for the additional time required for certain types of care. They recommend a review of the fee schedule to ensure that services linked to female anatomy, such as pelvic exams and intrauterine device (IUD) insertions, are adequately compensated.

Dr. Vanstone notes that while physicians are responsive to patient expectations, this adaptability can have mixed outcomes. “This is not necessarily a bad thing, as it is likely to result in satisfied patients whose needs are well met,” she emphasizes.

The implications of these findings extend beyond individual income disparities. The authors conclude that understanding physician responses to patient expectations could inform workforce planning and promote team-based care that recognizes the diverse backgrounds and skills of physicians. This approach aims to enhance patient outcomes while addressing systemic inequalities in the healthcare system.

For more details on this study, refer to “Family physician pay inequality: a qualitative study exploring how physician responses to perceived patient expectations may explain gender, race, and immigration status pay differences,” published in the Canadian Medical Association Journal in 2025. The DOI for the study is 10.1503/cmaj.250665.