Gender Pay Gaps in Medicine: Moving from Explanations to Action

Abstract

A lmost one half of medical school students are now women, and women make up over one third of the total physician workforce. Yet gender inequities in physician compensation persist, with reported gender-based pay gaps of 16 to 37%.1 Many potential explanations for this pay gap have been suggested, including prioritization of work-life balance, rates of working part-time, specialty choice, years of experience, fewer women in leadership roles and in senior positions, and lack of mentorship and sponsorship for women to promote career advancement. Prior studies have sought to control for many of these and found persistent gender disparities, but have thus far failed to account for the exact quantity and composition of hours worked (e.g., performing procedures versus teaching).The study by Apaydin et al. 2 in this issue of the Journal of General Internal Medicine sought to address this gap in the literature by using survey data from 30 diverse physician practices across six states to assess how much of the gender pay disparity could be explained by specialty choice, time worked and composition of those work hours, fraction of procedural time, type of compensation, number of years in practice, and demographics. The authors report a raw, absolute difference of close to $100k in yearly salary between men and women. Approximately $40k of this difference was attributable to practice characteristics, $13k was attributable to specialty choice (more women were in primary care specialties and more men performed procedures), $10k was attributable to number of hours worked, and $2k was attributable to composition of hours worked. In their full model, 70% of the gender-based pay disparity was explained by all included variables, including the quantity and composition of hours worked, leaving 30% of the disparity still unexplained.While this study successfully identifies some additional, modest contributors to and mediators of the gender-based disparity in compensation that may act as targets for interventions, future efforts should move beyond explaining the residual 30% income gap. Rather, the field of medicine should begin testing approaches to mitigate the observed gender pay disparity in both identified and unidentified causes of the disparity.Given that practice characteristics and specialty type explained a large portion of the overall gender pay gap, attention should be paid to the cultural influences in medical school that may deter women from pursuing procedural specialties.3 Indeed, in this sample, only 4% of women were in medical or surgical specialties, compared to 12 and 19% of men, respectively. Addressing the underlying influences that dissuade women from pursuing procedural specialties during medical school may contribute to closing the gender pay gap.In addition to supporting equal opportunities for men and women pursuing medical and surgical specialties, the disparity in pay between procedural and cognitive specialties and differences in reimbursement models should also be examined and addressed. The dispari...

Gender and rank salary trends among academic dermatologists

“…Our results corroborate previous findings highlighting the gender salary gap within dermatology ( Roy, 2018 , Weeks and Wallace, 2007 ). However, there appears to be a trend toward closing this gap: The overall median salary for women over this 5-year period increased by almost 20% but only increased by around 9% for men.…”

“…Gender disparity in salary and representation is a major ongoing issue in academic medicine ( Roy, 2018 , Weeks and Wallace, 2007 ). Although women composed almost half (47.9%) of dermatologists in Canada and the United States in 2018, they earned a 28% lower median salary than men, and only 26.1% of chiefs/chairs were women ( Shah et al, 2018 , Weeks and Wallace, 2007 ).…”

Closing the gender pay gap in Canadian medicine

“…Numerous studies, mostly from the United States and the United Kingdom, have shown a clear gender pay gap among phys icians. [7][8][9][10][11][12][13] This effect is seen in clinical, 14 research 15 and aca demic 16,17 environments. Inequities start at the early stages of a medical career, 18,19 deepen with time, 20 continue into retire ment 21 and affect lifetime wealth, 22 with estimates as high as $2.5 million over a 30year career.…”

Gender-based differences in physician payments within the fee-for-service system in Ontario: a retrospective, cross-sectional study

“…Our results are comparable to those of similar studies that have evaluated physician salaries in multiple jurisdictions. [2][3][4][5][6][28][29][30] Studies evaluating specific subgroups of physicians have found sex-and gender-based salary discrepancies among research, academic and clinical physician groups. 2,7,9,31,32 Similar to our findings, previous studies found that female physicians earned less than male physicians at the start of their careers, and that the income difference grew with time.…”