There have been numerous studies on the gender wage gap, and while there remains a lot to elucidate, a lot is known. For example, Sasser in 2005 identified that female physicians prior to marrying and having children, have higher earnings and then chose to decrease their hours - therefore the attribution was to choice rather than to unexplained disparities. However, a large volume of data seem to indicate the opposite - and this is hardly confined to medicine as a specialty alone. For example, Lo Sasso and colleagues found that during the early 2000s, the gender wage gap actually progressively increased in New York. This trend clearly overrides political implications that more conservative regions would have a larger gender wage gap due to lower protections. Larger cities, including the progressive city of Austin, Texas seem to have the larger wage gap. The key question is why?
According to the World Health Organization (WHO), women constitute 70 percent of health and social sector workers, but are paid on average 28 percent less. This decreases to 11 percent once there is correction for occupation and working hours. While this study is more holistic than just physicians alone, it does point towards a systemic problem in the way female physicians are compensated. The American College of Physicians (ACP) recently took a stronger position on this issue in clearly stating that although medical schools have been nearly 50 percent female for a number of years, this has not translated into increased female leadership. This therefore eliminates the “pipeline” issue due to gender imbalance. In Australia, the addition of children seemed to accelerate the male “breadwinner” effect whereas set female physicians back by several years. At the very minimum, this indicates that the gender gap issue is not unique to the United States.
Meyerson and colleagues cleverly demonstrated that female residents were given far less autonomy to make critical operative decisions as compared to male residents. Many studies have similarly demonstrated that female graduates across several professions are less likely to negotiate offers for practice or job opportunities. This was well pointed out in our friend and colleague Maurice Schweitzer’s recent book “Friends or Foes.” They describe a well-regarded female professor who applied for a position and attempted to negotiate. This led to her offer being withdrawn. While it remains disturbing at a societal level that there is systematic discrimination against qualified female applicants, it remains all the more shocking in a field as egalitarian and holistic as medicine.
There remains a silver lining in Doximity’s data however. Here the data was self-reported, and therefore less susceptible to transparency issues. Overall female compensation rose 2 percent, whereas male compensation remained relatively flat. Another interesting finding was that when female physicians were independent contractors, the gender gap was significantly less. The reasons behind this remains unclear but highly relevant: 1) are female physicians more motivated to negotiate when they work for themselves and 2) are female physicians less motivated to negotiate when they are joining a group practice? Reason number one makes a lot of sense, and would seemingly be true regardless of gender, but reason number two calls a lot of our biases, regardless of gender, into question. For example, even in fields like medicine with a greater than 50 percent representation of female physicians, there still exists a similar percentage-wise pay disparity. It would stand to reason that there would be several female leaders in these fields, and while female leadership is underrepresented across the board, there would be some female leadership in these firms to help address large pay disparities.
In summation, clearly this seems to be an issue where we know a lot less than what we believe despite decades of research on gender wage gap disparities. While the gaps are not as large as they once were, despite equal educational achievements and training, female physicians do seem to lag behind male counterparts. This is not a unique finding of Doximity’s data, but is a confirmation of existing literature. What we do know is that these gaps cannot be attributed to family commitments and childcare responsibilities alone. It behooves us as a profession to study this issue and understand in a non-partisan, reflective fashion exactly what factors keep our female physician counterparts from realizing equivalent monetary compensation.
Arvind Chandrakantan, MD, MBA, FAAP is a practicing pediatric anesthesiologist in Houston, TX at Texas Children’s Hospital and Baylor College of Medicine. He is a 2018-2019 Doximity Author.
Adam C. Adler, MD is a practicing pediatric anesthesiologist in Houston, TX at Texas Children's Hospital.
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