Practice composition and sex differences in physician income: observational study.
Practice composition and sex differences in physician income: observational study.
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医生收入的执业构成和性别差异：观察性研究。
DOI：
10.1136/bmj.m2588
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Jena,AnupamB
中科院分区：
文献类型：
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作者：
Whaley,ChristopherM;Arnold,DanielR;Gross,Nate;Jena,AnupamB
目的探讨男女医师收入差异是否因执业医师性别构成不同而不同。设计回顾性观察性研究。设定2014-18年度美国全国医生薪资调查。研究对象来自9848个团体诊所的18802名医生(按男性医生比例分类：≤50%，>；50%-75%，>；75%-90%，>；90%)。主要观察指标在对医生专业、经验、工作时间、临床工作量、执业类型和地理位置进行多变量调整后，医生收入与医生执业性别构成的性别差异。结果在11 490名非外科专科医生中，男性医生占50%或以下的医生的绝对调整后的性别年收入差异(男性与女性)为36 604美元(GB 29 663；欧元32 621)(95%可信区间为24 903美元至48 306美元；相对差异为11.7%)，而男性医生至少有90%的诊所的调整后的性别差异为91 669美元(56 587美元至126 571美元；相对差异19.9%)。在外科专科医生(n=3483)中也观察到了类似的结果，在50%或以下的男性医生执业的情况下，调整后的性别绝对年收入差异为46503美元(42198美元至135205美元；相对差异10.2%)，而在90%以上的男性医生执业的情况下，调整后的性别差异为149460美元(86040美元至212880美元；相对差异26.9%)(差异P=0.06)。在初级保健医生(n=3829)中，收入的性别差异与男性医生在执业中的比例无关。结论：在非手术和外科专科医生中，男性医生比例最高的诊所中，性别收入差异最大，即使在对可能解释收入性别差异的因素进行详细调整后也是如此。
Objective To assess whether differences in income between male and female physicians vary according to the sex composition of physician practices. Design Retrospective observational study. Setting US national survey of physician salaries, 2014-18. Participants 18 802 physicians from 9848 group practices (categorized according to proportion of male physicians≤ 50%,> 50-75%,> 75-90%, and> 90%). Main outcome measures Sex differences in physician income in relation to the sex composition of physician practices after multivariable adjustment for physician specialty, years of experience, hours worked, measures of clinical workload, practice type, and geography. Results Among 11 490 non-surgical specialists, the absolute adjusted sex difference in annual income (men versus women) was $36 604 (£ 29 663;€ 32 621)(95% confidence interval $24 903 to $48 306; 11.7% relative difference) for practices with 50% or less of male physicians compared with $91 669 ($56 587 to $126 571; 19.9% relative difference) for practices with at least 90% of male physicians (P= 0.03 for difference). Similar findings were observed among surgical specialists (n= 3483), with absolute adjusted sex difference in annual income of $46 503 ($42 198 to $135 205; 10.2% relative difference) for practices with 50% or less of male physicians compared with $149 460 ($86 040 to $212 880; 26.9% relative difference) for practices with at least 90% of male physicians (P= 0.06 for difference). Among primary care physicians (n= 3829), sex differences in income were not related to the proportion of male physicians in a practice. Conclusions Among both non-surgical and surgical specialists, sex differences in income were largest in practices with the highest proportion of male physicians, even after detailed adjustment for factors that might explain sex differences in income.