One response to this question is “yes!” An analysis of the comparative activity rates of male and female hospital consultants in the English NHS (Bloor KE, Freemantle N, & Maynard A 2008) found that across all specialties, women doctors processed less patients. On average, male consultants managed 10-15% more patients than their female counterparts.
Obviously this is an incomplete basis for determining productivity, let alone efficiency and pay. One light-hearted explanation of the differential activity rates of male and female consultants is that women listen, unlike their male counterparts! Thus, female consultants may process fewer patients but perhaps their diagnostic skills are superior and this may produce better outcomes for patients? Whilst plausible, these contentions cannot be tested. The NHS has activity data but comparative information about diagnostics and patient outcomes are absent.
Another explanation of female low pay is that their progression through the profession is in its early stages
There are other reasons why female doctors in primary and hospital practice may be paid less than men. An obvious issue is biology, with women taking time off to have and care for children. This may lead to subsequent periods of part-time work and the challenges of reskilling after periods of home activity.
Another explanation of female low pay is that their progression through the profession is in its early stages. It is relatively recently that medical school intakes exhibited female majorities. The progression of these graduates through medicine takes time and exhibits differences across specialties, e.g. surgery and orthopaedics continues to be dominated by males. It is in specialties such as these, as well as diagnostics and anaesthesia, where waiting list “overtime” and private practice opportunities are greatest. In hospital medicine and general practice where women increasingly dominate, such “goodies” are all too rare!
The nice issue is how pay differentials will develop in the future. Medicine will increasingly be female dominated in terms of numbers. Given the differential activity rates of male and female consultants, more consultants will have to be recruited in future if activity levels are to be maintained. An obvious mitigating policy to such expensive expansion of the hospital doctor stock would be changes in skill mix, i.e. replacing consultant endoscopists and anaesthetists with nurses.
Competency will also have to be better demonstrated in the award of clinical excellence payments to consultants
Alternatively, doctors pay growth in times of economic recession will have to be restricted to fund new appointments. Such an approach might involve a sub-consultant grade with performance conditions that have to be met before promotion to full consultant and the introduction of a broader salary scale with thresholds that can only be passed after demonstration of competency.
Competency will also have to be better demonstrated in the award of clinical excellence payments to consultants. These continue to exhibit differences in gender and ethnicity. The English NHS is investing in the production of comparative activity, cost and outcome data at the patient level. In the next three years the performance of all practitioners will become more transparent, affecting clinical excellence awards as well as job tenure and pay progression in both primary care and hospitals.
The development of such comparative performance data to interrogate efficiency and productivity in primary care is slow. Whilst the quality outcome framework (QOF) has incentivised services, some of which are poorly evidence based in relation to cost effectiveness, rigorous performance management of GP hospital referral rates and prescribing remains elusive. That together with incomplete data on consultation rates indicates clearly that in the times of parsimony ahead, more detailed analysis of comparative performance is as inevitable as nurse substitution of expensive GPs. Such scrutiny will inevitably be related to take home pay.
It is essential that pay is better linked to productivity
Whilst debate about gender differentials in pay may stimulate immediate debate, recession and its effects on the NHS is likely to affect the absolute and relative pay of medical practitioners even more in the next decade. It is essential that pay is better linked to productivity, where productivity is not merely comparative activity but also comparative cost and patient outcomes at the practitioner level. Such reforms will be contentious and gender issues will certainly continue to feature in the ensuing competition for taxpayers’ resources.
