To explore the connection between primary care physicians' race and sex and their annual incomes, we used restricted versions of Community Tracking Study Physician Surveys administered in 1998-99, 2001-02, and 2004-05. Compared to white male primary care physicians, we inconsistently found lower yearly incomes for their black male peers but consistently found significantly lower incomes for their female peers of any race, after differences in work effort, physician characteristics, and practice characteristics were adjusted for. Sex-based differences persisted over time. Our findings suggest that addressing the underlying causes of sex-based income differences should be a priority for health professional organizations, particularly as more women enter the physician workforce.