Female doctors spend more time with patients, and it could cost them

Women are seeing fewer patients and putting in more hours on documenting health records, a report from athenahealth says. As a result, female clinicians could end up earning less.

Women clinicians are seeing fewer patients and spending more time with them, potentially hurting their income.

A new report from athenahealth, the Massachusetts-based healthcare technology company, showed female clinicians see fewer patients than male doctors in a typical week. Female doctors also spend more time in documenting the records of each patient.

Female clinicians scheduled an average of 60 encounters with patients per week, while male clinicians scheduled an average of 73 patient encounters each week. They both spent the same amount of cumulative time documenting patient records, so women are spending 20% longer on documentation per patient than male clinicians, the athenahealth report said.

Women clinicians are likely taking a hit on earnings and also can be at greater risk for burnout, said Jessica Sweeney-Platt, athenahealth's vice president of research and editorial strategy.

“If you are seeing fewer patients in this healthcare world we live in, you’re probably making less money,” she said in an interview.

Sweeney-Platt said it’s another argument for compensating clinicians based on the quality of their care rather than volume. Doctors are experiencing more stress and burnout in the pandemic, and moving to a value-based care model could help alleviate the pressure on doctors, particularly female clinicians.

“If we were rewarding healthcare providers more on quality and patient outcomes and less on the sheer volume of work, I think that would be part of the solution here,” she said.

In the study, athenahealth said it examined more than 8 million records compiled by more than 14,000 clinicians in a five-month period in 2021.

Some women clinicians in certain specialties are putting in much more time on documentation than men on each patient encounter.

Cardiology: female clinicians’ documentation time is 62% higher than male counterparts.

Neurology: female clinicians’ documentation time is 40% higher

Orthopedic surgery: female clinicians’ documentation time is 33% higher

The report also found that clinicians are spending a substantial amount of time after hours working on patient health records.

On average, clinicians spend 21.5% of their electronic health record time outside of patient appointment hours, the report found. Gastroenterologists and orthopedic surgeons spend the highest percentage of time outside of patient appointment hours (31.3% and 30.6%, respectively).

The study indicated women are spending more time in their “off-hours” working on patient records.

Doctors typically work on records in their off hours, sometimes dubbed “pajama time." But Sweeney-Platt said that term doesn’t do justice to the stress it puts on clinicians.

“Physicians don’t mind working long hours,” she said. “This is not about long hours. This is about the type of work being asked of them in their off hours.”

Doctors are willing to spend time reading a journal article to learn more about a patient’s condition. “That's why they got into medicine,” she said. But the extra hours on documenting records can be wearying.

Researchers have previously shown women physicians spend more time with their patients than men.

A study published in the New England Journal of Medicine in October 2020 found women primary care physicians spend, on average, an additional 2.4 minutes with their patients. The study showed women generated 11% less in annual revenue because they were offering more direct patient care.

Women doctors earn $2 million less than male physicians over a 40-year career, according to a study published Dec. 6 in Health Affairs. Among surgical specialists, women typically earn $2.5 million less over their careers, that study found. Female primary care physicians earned about $900,000 less over their careers, the study found.

In addition, the COVID-19 pandemic appears to be having a disproportionate impact on women doctors, according to a study published in Jama Network Open in November. Women doctors were more likely to assume child care responsibilities, work from home or reduce their hours, the study found.

Healthcare leaders have said encouraging more women to pursue careers as doctors is critical to addressing the nation's physician shortage. Women account for 36% of the nation's doctors.

Sweeney-Platt said she hopes the data generates more conversation about changing business models that put less pressure on doctors seeing a high volume of patients.

“It does suggest to me that some of the fundamental things we could do as a healthcare system would be changes to the payment system,” she said. “It would benefit everyone but it would have a disproportionate benefit on female clinicians.”