Study Reveals How Patient Expectations Impact Physician Incomes

A recent study published in the Canadian Medical Association Journal highlights the significant influence of patient expectations on physician incomes in Canada. Researchers from McMaster University conducted a qualitative analysis involving interviews with 55 family physicians in Ontario, revealing that disparities in income related to gender, race, and immigration status persist among medical practitioners.

According to Dr. Meredith Vanstone, a professor in the Department of Family Medicine and Canada Research Chair in Ethical Complexity in Primary Care, these pay disparities remain evident even within specialties and after adjusting for total hours worked. “Pay disparities related to gender, race, and immigration status persist among Canadian physicians, even within specialties and after adjusting for hours worked,” she stated.

The study found that physicians often adjust their practice and interactions based on perceived patient expectations, which vary according to the identities of both the physicians and their patients. Dr. Monika Dutt, a Ph.D. candidate at McMaster University and family physician, noted, “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 more women and international medical graduates enter the medical workforce in Canada, understanding and addressing these income inequalities becomes increasingly critical. The study indicates that specialties with a higher proportion of female physicians are witnessing declining incomes relative to others.

Understanding the Financial Implications

The researchers emphasize that longer, more comprehensive patient interactions can limit the number of appointments a physician can handle. This is particularly concerning for women physicians, who may face financial disadvantages in compensation models that depend on patient volume. The authors suggest that compensation models should be adjusted to reflect the additional time required for certain types of care, ensuring that services related to female anatomy, such as pelvic exams and IUD insertions, are adequately compensated.

“Since providing longer, more comprehensive patient interactions limits the number of appointments or services that physicians can provide, women may experience financial disadvantages in compensation models that depend on roster size or patient volume,” the authors wrote in the study.

Despite these challenges, Dr. Vanstone pointed out that responsiveness to patient expectations can lead to improved patient satisfaction. “Ontario family physicians are responsive to the expectations of their patients. This is not necessarily a bad thing, as it is likely to result in satisfied patients whose needs are well met,” she emphasized.

The findings of this study may have broader implications for physician workforce planning. The authors conclude that it is essential to ensure team-based care that takes into account the backgrounds and skills of physicians to improve patient outcomes.

This research sheds light on the complexities of income disparities among physicians in Canada, urging stakeholders to evaluate compensation structures to promote equity within the healthcare system. This is particularly relevant as the medical landscape continues to evolve with increasing diversity among practitioners.

For further details, refer to the study titled “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.