Research has shown that a gender pay gap persists in medicine and many other fields. On average, male primary care doctors make almost 25% more than their female counterparts, and the gap widens for specialists to 31%. Furthermore, though women comprise more than 50% of physicians in pediatrics, only a fraction hold leadership positions. Women are also underrepresented as first authors, receive fewer and smaller grants, and are recognized for their contributions less often. The problem has been well-defined, but what are some possible solutions?
According to Dr. Shikha Jain, medical oncologist and founder of the Women in Medicine Summit, the first step is acknowledging that it is a systemic problem, not a woman problem. “I had always felt that if there were barriers or challenges, they were because of something that I had done. I wasn't good enough; I wasn't smart enough,” she shared. “It was seeing what other women were talking about and realizing that many women had experienced the same barriers I had that showed me it wasn't us.”
A critical second step is gathering data. Dr. Lisa Rotenstein, medical director at Brigham and Women's Hospital, said, “Some companies have experimented with pay transparency, and it happens to some extent at public medical institutions because their data is publicly available.” Why is access to data so important? Dr. Rotenstein explained that it “informs both sides of the table. … It’s important when you're coming to a negotiating table when you have an offer in front of you. And even on the employer side, it’s useful to have data about the different combinations of packages that people receive and how that ends up playing into total compensation and resources.”
In addition to these two steps, there are a number of strategies that could help close the gap in gender pay and advancement. One such strategy is to consider what types of work lead to career growth. Dr. Jain noted that women are more likely to volunteer for additional responsibilities that don’t lead to promotions, like those in the arena of diversity and equity efforts and physician wellness. “Women are doing a lot of the invisible ‘third-shift’ work that is necessary for institutions and organizations to succeed and are not getting recognized for it. They’re getting penalized for it,” she lamented. Salary and promotions are based on publications, grants, and RVUs. Clinical demands, family responsibilities, and third-shift work leave little time for these pursuits.
It’s also important to consider patient interactions when evaluating performance and pay. Women physicians are more likely to treat women patients and patients with more complex conditions, both of whom require more time during visits. Dr. Rotenstein recalled one study where women primary care physicians spent more time with patients, which resulted in lower charges and less pay at the end of the year. However, studies have shown that patients of women surgeons had better outcomes and fewer readmissions than those of male surgeons. There are similar findings of better outcomes for hospitalized patients cared for by women physicians. Such findings underscore how much of an impact equitable leadership can have. This makes sense to Dr. Jain, who said that when “leadership is representative of the patient population you serve, you actually have better patient outcomes. There have been numerous studies that have shown that when you have equity in leadership and within your institutions, you have better retention, you get more awards, and it's financially beneficial.”
Another way to approach gender equity is to experiment with new payment models that do not penalize physicians for spending more time with patients, especially when this leads to better outcomes. Standardizing the RVUs associated with similar procedures can help too. “Women performing procedures of similar complexity as men in a different field are getting paid less per RVU,” Dr. Jain said. “One study found that a less complicated urology procedure was reimbursed at a higher rate than a comparable ob/gyn procedure.”
Dr. Rotenstein advised that health care systems have an opportunity to address the reasons why women physicians are found at disproportionately lower ranks in academic medicine. One way to do this is to create multiple paths to academic advancement. Instead of focusing mainly on the number of grants secured or papers published, she suggested factoring in excellence in teaching or clinical work, as UCLA and Duke have done. “The teaching or clinical work that women physicians undertake is important to society and the institution, but in many places, not rewarded in the same way as research productivity,” says Dr. Rotenstein.
In terms of other measures, Dr. Rotenstein also suggested providing grants to help families with childcare so that physician parents can attend conferences and meetings. Funding agencies can support equity by providing flexibility and funding in sponsored research programs for family or personal needs. “There are some institutions that give physicians extra time on the tenure clock or providing bridge funding,” noted Dr. Rotenstein, which can help physicians of all genders take parental leave without sacrificing their career development.
There is a need for gender equity in the hiring and selection process as well. “Making publicity and evaluation processes more equitable can help ensure women physicians are advancing in a way that is representative of their contributions,” said Dr. Rotenstein. Many leadership positions are currently filled without a formal posting. Job opportunities should be widely publicized so a diverse pool of candidates can apply. At the point where applicants are being evaluated, including women on search and promotion committees can also have a big impact on equity. In 2012, MD Anderson adopted a policy that required search committees to include at least 35% of women or members of a minority community. In the nine years since the rule was implemented, the percentage of women in leadership positions at the center has grown from 14% to 36%. Similarly, the UCSF School of Medicine now requires at least half of every committee making personnel decisions to be either women or minorities, and the school has experienced a 50% increase in endowed chairs held by women.
There is no one-size-fits-all approach to fixing the inequities facing women physicians, and these are just a few ways to move toward parity. Changing medical culture takes time. Nevertheless, there is a strong business case for recognizing the value that women physicians provide to their patients and their health systems’ bottom lines. And more importantly, now is the time to recognize the myriad contributions of women physicians in health care and give them the respect they are long overdue.
How have you seen work and pay discrepancies resolved in your workplace? Share in the comments!
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