We shouldn't be penalizing doctors for doing what patients need
A new study from Ontario has given numerical form to a quiet injustice: female family physicians, who spend measurably more time with each patient and appear to produce better health outcomes, are systematically paid less for doing so. The fee-for-service model at the heart of Ontario's family medicine compensation structure rewards volume over depth, effectively penalizing the very qualities — empathy, thoroughness, relationship-building — that research suggests make medicine work. It is a story not only about gender and pay, but about what a health system chooses to value when it decides how to keep score.
- Female family doctors in Ontario earn roughly $45,500 less per year than male colleagues, not because they work less, but because they work differently — and the payment system cannot tell the difference.
- Spending four additional minutes per patient visit may sound modest, but compounded across thousands of appointments it creates a financial penalty so steep that closing the gap would require women to work two extra hours every single day.
- The fee-for-service model creates a perverse arithmetic: the more time a doctor invests in a complex patient, the less she earns per hour, turning compassionate care into a financial liability.
- Some physicians, like Dr. Kim Lazar at North York General, are absorbing the cost personally — blocking 30-minute appointments for patients with eating disorders and depression, choosing depth over income.
- A blended compensation model launching in April 2026 would allow physicians to bill for time rather than volume alone, offering a structural remedy to what has until now been a structural wound.
A study published this week in the Canadian Family Physician journal has put a dollar figure on something long suspected: female family doctors in Ontario spend 15 to 20 percent more time with each patient than their male counterparts — roughly four extra minutes per visit — and the health care system penalizes them financially for it. Surveying over 1,050 physicians, researchers from the Ontario Medical Association and McMaster University estimated the resulting income gap at $45,500 annually, a deficit women could only close by working approximately two additional hours every day.
The mechanism is the fee-for-service compensation model, which pays doctors based on the volume and type of services rendered. It is a structure that rewards speed and penalizes depth — the more time spent with any one patient, the lower the effective hourly rate. Dr. Zainab Abdurrahman, president of the Ontario Medical Association, put it directly: the system is punishing doctors for giving patients what they actually need.
Some physicians have chosen to absorb that punishment. Dr. Kim Lazar at North York General Hospital books 30-minute appointments rather than the standard 15, because her patients — many managing eating disorders and depression — require it. The financial cost is real, and she accepts it.
The extra time female physicians invest does not appear to be incidental. Research has linked their more empathetic, partnership-oriented communication style to fewer emergency room visits and hospitalizations among their patients, suggesting that the investment in relationship pays dividends downstream.
Change may be arriving. Beginning in April 2026, Ontario will introduce a blended compensation model allowing physicians to bill for time spent on both direct and indirect patient care. Abdurrahman sees it as a chance to finally align the economics of family medicine with its actual values — and in an era of rising health misinformation, she argues, the ability to build genuine trust with patients has never mattered more.
A study released this week in the Canadian Family Physician journal has quantified something many suspected but few could prove: female family doctors in Ontario are spending substantially more time with each patient than their male counterparts, and the health care system is paying them less for it.
Researchers at the Ontario Medical Association and McMaster University surveyed over 1,050 physicians between August and October 2023, asking them to report on their practice patterns. The numbers were striking. Women in family medicine spend 15 to 20 percent more time with patients than men—roughly four additional minutes per visit for the most common type of examination. That difference compounds across a career. The study estimates it translates to an annual income gap of $45,500, a gap that would require female physicians to work approximately two extra hours each day to close.
The culprit, researchers argue, is the fee-for-service compensation model that dominates family medicine in Ontario. Under this system, doctors are paid based on the volume and type of services they provide. The structure creates a perverse incentive: spend more time with a patient, and you earn less per hour worked. Spend less time, see more patients, and your income rises. It is a system that rewards speed over depth, throughput over care.
Dr. Zainab Abdurrahman, president of the Ontario Medical Association, framed the problem plainly: the current system penalizes doctors for doing what patients actually need. "We shouldn't be penalizing doctors for doing what patients in the system really need," she said. Dr. Kim Lazar, a family physician at North York General Hospital, has made a deliberate choice to buck the incentive structure. She blocks off 30-minute appointments instead of the standard 15 minutes, a decision driven by the reality of her patient population. Many of her patients struggle with eating disorders and depression. Their needs are complex. They require time. "Obviously patients who have complex health needs and mental-health concerns, which leads to longer visits and more frequent visits, would prefer that type of care," Lazar said. She has chosen to provide it, knowing the financial cost.
The study suggests that the extra time female physicians invest may reflect differences in communication style. Research has shown that female doctors tend to engage in longer discussions and adopt a more empathetic, partnership-building approach to care. This is not incidental to their work—it appears to produce measurable results. A 2016 study found that patients who see female physicians experience fewer emergency room visits and hospitalizations, suggesting that the additional time spent on relationships and understanding may prevent downstream complications.
Relief may be coming, though slowly. Beginning in April 2026, Ontario family physicians will have access to a new blended compensation model that allows them to bill for time spent on direct and indirect patient care, as well as clinical administration. Abdurrahman sees this as a pathway toward removing the structural disadvantages that currently penalize patient-centric practice. In an era of rising misinformation about health, she argued, the ability to build genuine relationships with patients has become more important, not less. A payment system that makes those relationships economically viable would represent a fundamental shift in how the profession values its work.
Citações Notáveis
We shouldn't be penalizing doctors for doing what patients in the system really need.— Dr. Zainab Abdurrahman, Ontario Medical Association president
We need to celebrate the fact that female family physicians do provide more patient-centric care and not penalize female family positions for this.— Dr. Kim Lazar, family physician at North York General Hospital
A Conversa do Hearth Outra perspectiva sobre a história
Why does the fee-for-service model create this particular problem for women?
It's not that the model was designed to disadvantage women specifically. It's that it rewards volume—seeing more patients, doing more billable procedures—and penalizes time investment. Women in the study spend more time per patient. Under fee-for-service, that means lower hourly earnings. A man who sees 20 patients in a day earns more than a woman who sees 15, even if her patients have better outcomes.
But the study shows female doctors are actually providing better care. Fewer hospitalizations, fewer ER visits. Isn't that valuable?
It is valuable—to patients, to the health system long-term, to public health. But the payment structure doesn't capture that value. It only captures the transaction. A 30-minute appointment with complex care counts the same as a 15-minute visit, financially. The system doesn't reward prevention or relationship-building.
So this is a women's issue, or a system design issue?
Both. The system affects anyone who practices this way, but the data shows women disproportionately do. Whether that's socialization, choice, or some combination, the result is the same: they're economically penalized for their approach.
Will the new blended model actually fix it?
It could, if it's implemented well. If doctors can bill for time spent on patient care and administration, not just procedures, then the extra four minutes per visit becomes billable. But it depends on how the model is structured and whether it's actually adopted widely.
What happens to the doctors in the meantime?
They keep working the way they believe is right, and they keep earning less. Some, like Dr. Lazar, have made peace with that choice. Others may not have the financial flexibility to make it.