Summer 2025 (Volume 35, Number 2)

The Rheumatology Gender Pay Gap

By Angela Hu, MD, FRCPC; Barbara Blumenauer, MD, FRCPC; May Kazem, MD, FRCPC, MHA; Corisande Baldwin, MD, FRCPC, MSc; Raheem B. Kherani, MD, FRCPC, MPHE; Shahin Jamal, MD, FRCPC; Heather Day, MD, FRCPC; Jacqueline Stewart, MD, FRCPC; Grace Wright, MD, PhD; Gwenesta Melton, MD; Kam Shojania, MD, FRCPC; Diane Lacaille, MDCM, FRCPC, MHSc; and Mollie Carruthers, MD, FRCPC

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It has been increasingly recognized that despite Canadian female physicians doing the same clinical work as their male counterparts, they are systemically paid less.¹ Why is this the case, when fee-for-service billing codes are the same for everyone? In British Columbia, we sought to identify some of the root causes for this inequity amongst rheumatologists.²

A survey was designed by the Division of Rheumatology Equity Committee at the University of British Columbia. We conducted a cross-sectional study where this anonymized survey was sent out to members of the British Columbia Society of Rheumatologists (BCSR). We heard from 49 rheumatologists across the province, capturing two thirds of all practising members. In terms of remuneration, gross fee-for-service billings were reported and did not account for overhead, which can be quite variable and substantial, up to 48.6%.³

We found that, on average, men and women worked nearly identical hours per week (42.5 and 42.6 hours respectively). However, 71% of women earned less than $400,000 annually, compared to only 33.5% of men. Medical Services Plan (MSP) data echoed this gap: between 2018 and 2022, women rheumatologists earned 31.2% less in terms of gross earnings.⁴

What is behind this disparity? One key factor appears to be how time is spent. Women reported spending more time on each initial consultation—50.4 minutes versus 40.8 minutes for men. Women also saw a higher frequency of complex connective tissue disease patients and fewer patients with mechanical concerns. (Figure 1).²

In BC, most physicians and rheumatologists specifically are compensated in a fee-for-service model. This disincentivizes care for complex and time-consuming patients. Historically, the predominant belief was that female physician remuneration is lower as women work fewer hours in order to fulfill other roles, such as parental responsibilities. However, this is not the case, as our study highlights that female and male rheumatologists are working the same weekly hours. There are nuanced factors therefore contributing to these pay disparities, including longer time spent on consultations, greater frequency of patients with complex disease, and other patient-specific factors where higher numbers of patients with psychosocial vulnerabilities are referred to female physicians.⁵ A counterargument to this is that male physicians are seeing increased numbers of patients overall, given their shorter consult time length. In a system already burdened with long specialist wait times, it is important to also balance this consideration.

In contrast to sociocultural or biological factors, the structuring of medical benefit schedules is a modifiable factor under the jurisdiction of government bodies and provincial medical associations. One such way that the BC Medical Service Commission has already helped to address this inequity is by increasing the compensation for complex consults (>53 minutes). Exploring alternative payment models—like the recently introduced Longitudinal Family Physician Payment Model—could be another step toward fairer compensation.

We all have a role in recognizing the different ways that women and men practise medicine, but this is only the beginning. It is time we ensure those differences are equally valued.

Selected References:

1. Cohen M, Kiran T. Closing the gender pay gap in Canadian medicine. CMAJ . 2020;192:E1011-E1017. https://doi.org/10.1503/cmaj.200375.

2. Hu A, Blumenauer B, Kazem M, et al. Explaining the gender pay gap: Lessons from rheumatology. BCMJ. 2025; 67(1). https://bcmj.org/articles/explaining-gender-pay-gap-lessons-rheumatology.

3. Doctors of BC. Overhead Study – Survey of Physicians: Executive Summary. Vancouver, BC: Doctors of BC; 2019.

4. Ministry of Health. MSC financial statement (blue book). Accessed 14 November 2024. www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/msp/publications.

5. Ruzycki SM, Sunba S, Ejaredar M, et al. Addressing the root causes of the sex-based pay gap in medicine in Canada. CMAJ. 2024;196(12):E416–E418. doi: 10.1503/cmaj.231518.

Angela Hu, MD, FRCPC
Clinical Instructor,
Division of Rheumatology,
Faculty of Medicine,
University of British Columbia

Barbara Blumenauer, MD, FRCPC
Rheumatologist (Kamloops BC)

May Kazem, MD, FRCPC, MHA
Clinical Instructor,
Division of Rheumatology,
Faculty of Medicine,
University of British Columbia

Corisande Baldwin, MD, FRCPC, MHA
Clinical Assistant Professor,
Division of Rheumatology,
Faculty of Medicine,
University of British Columbia

Raheem Kherani, MD, FRCPC, MPHE
Clinical Associate Professor,
Residency Program Director,
Division of Rheumatology,
Faculty of Medicine,
University of British Columbia

Shahin Jamal, MD, FRCPC
Clinical Professor,
Division of Rheumatology,
Faculty of Medicine,
University of British Columbia

Heather Day, MD, FRCPC
Rheumatologist (West Vancouver, BC)

Jacqueline Stewart, MD, FRCPC
Retired rheumatologist (Penticton, BC)

Grace Wright, MD, PhD
President, Association of Women in Rheumatology

Gwenesta Melton, MD
Vice-President, Association of Women in Rheumatology
Kam Shojania, MD, FRCPC
Head of Rheumatology, Vancouver General Hospital,
Clinical Professor,
Division of Rheumatology,
Faculty of Medicine,
University of British Columbia

Diane Lacaille, MDCM, FRCPC, MHSc
Scientific Director,
Arthritis Research Canada
Professor,
Division of Rheumatology, Faculty of Medicine,
University of British Columbia

Mollie Carruthers, MD, FRCPC
Clinical Investigator,
Arthritis Research Canada,
Clinical Associate Professor,
Division of Rheumatology, Faculty of Medicine,
University of British Columbia