The Doximity 2019 Physician Compensation Report surveyed almost 90,000 physicians and revealed gaps in salary between gender, geographic location, specialties, and practice types. The most recent report queried U.S. physicians working 40 hours a week or more and compared trends with data from the last two annual reports.
This is an important resource for physicians as medical school debt rises and well-documented gender wage gaps persist. Several sources show that doctors with more financial stress are at the highest risk for burnout and suicidal ideation, so empowering them with financial data has significant benefits for both wealth and wellness. This report provides information that can guide physicians searching for jobs, help them determine their worth during contract negotiations, and equip them to promote system-based improvements.
Women comprised 28 percent of survey respondents. Family Medicine, Internal Medicine, and Anesthesiology were the most common specialties, while Obstetrics-Gynecology and General Surgery hfad the most representation amongst surgical specialties. Data on variables such as ethnicity could offer additional insights in future reports, especially since African American physicians are paid an average of $50,000 less than their Caucasian counterparts. The Doximity report is a valuable and necessary starting point because an alternative resource can cost hundreds to thousands of dollars.
The 2019 Doximity report again confirms that women are compensated less than men. This gender wage gap persists across all specialties, metropolitan areas, and practice types. In the most recent report, women physicians made $90,490 less than men, a decrease from the $105,000 gap noted in the 2017 report, and a little bit less than the $91,284 gap in the 2016 report. The gender wage gap means that women physicians make about $1 for every $1.25 that men make. Another way to think of the difference is to recognize that women physicians “work for free” from mid-September to the end of the year.
It’s interesting to note the $90,000 pay gap between urologists, 8 percent of whom are women, and obstetrician-gynecologists, who are 85 percent women. The reimbursement rates assigned by the Centers for Medicare and Medicaid Services (CMS) are higher for urologic procedures than for similar gynecologic procedures.
Women consistently earn less over their lifetime than men, a reality that impacts women’s ability to choose when they can retire, if they can afford college tuition for their children, and end of life health care or financial emergencies. Studies also show that women typically take on more debt in their lifetime and pay higher interest rates for education, mortgage, credit cards, and vehicles.
Nearly 70 percent of women physicians retire with less than 1 million in savings, compared to 53 percent of men. A New York study that surveyed more than 8,200 physicians over nine years demonstrated a $16,819 gender pay gap immediately after graduation from residency. That gap translates to nearly a one million dollar wealth gap after a thirty-year career ($16,819 at 4 percent for 30 years), or over 6 million dollars for female urologists facing a $104,000 gap.
Awareness of the pay gap can empower and motivate women to advocate for themselves in terms of career and workplace choices. Armed with concrete numbers, female physicians might feel more confident during negotiation discussions. Women may also be more emboldened to ask their peers about compensation. Consideration of the accumulated wealth gap might also lead more comfort in investing a comparably small sum to hire an experienced lawyer for negotiation and contract advice. The Doximity report and others like it can stimulate and normalize conversations about money. Moreover, women and men should support their female colleagues by formally and informally sharing information on salary, benefits, and negotiation strategy.
System-wide transparency may also lead to decreases in the gender wage gap. Studies on surgeons found that structured compensation plans did not alter men’s salaries and increased women’s salaries, decreasing (but not eliminating) the gap. Decisions on salary, funding, and promotions might be optimal when those in authority are blinded to gender and ethnicity to minimize the influence of implicit biases. Examining and restructuring processes that historically created the current systemic barriers is not only the right thing to do; it’s also codified in the law since 1964 as Title VII.
The law has failed to protect female physicians, and they are not alone. The Wall Street Journal reported that women earn less than men in all health care jobs. As leaders, physicians must take the reins on their own finances and lead by example for other health care professionals to do the same. Women make up 80 percent of the health care workforce, so this gender wage gap translates into massive gender-based losses of wealth. These realities underscore the importance of encouraging our nurses, physician assistants, therapists, and aids to speak up and vote on gender equity issues within their organizations. At the same time, it is essential to partner with healthcare executives, a majority of whom are men, to promote equity from the top down.
Culture is difficult to change, but there are a few emerging initiatives making progress on pay equity. Drs. Julie Silver and Michael Sinha collaborated with the American Medical Women’s Association to call for gender equity resolutions in every state medical society. Times Up Healthcare, a nonprofit launched in 2019, aims to sign on all health care employers to commit to pay equity. Compensation is only the tip of the iceberg for equity in health care. Feminem, an open-access resource for women working in Emergency Medicine, for instance, has attempted to reveal information on historically elusive parental leave benefits at major emergency physician groups and to recommend fair and evidence-based leave policies.
Eliminating the gap will require a multifaceted effort, from empowering and informing women to negotiate better to challenging the CMS on gender bias in procedure reimbursements. Men and women need to be transparent with each other about money, and administrators need to reflect on how they can achieve equity in their own systems regarding compensation and parental leave for all their employees. Most of all, the 2019 Physician Compensation Report needs to be disseminated far and wide, because the gender wage and wealth gap is not just a physician problem; it is a health care problem. Companies with more women on the board are more profitable, so workplace compensation is not a zero-sum game. When women win, everyone wins.
Dr. Joannie Yeh is a pediatrician as well as a 2018–2019 Doximity Author.
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