Are female physicians leaving money on the (operating room) table?

The studies don’t lie. Female physicians – while representing nearly half of new medical school graduates – earn far less than their male counterparts.

Blog: MOC, recertifications are ‘cancers’ doctors should rally against

In 2013, the Journal of the American Medical Association reported a $56,000-a-year difference, while the U.S. Census Bureau same year found that female physicians received $140,036 per year compared to a $202,533 median income for men.

Why Women Doctors Earn Less

The wage gap can be explained partly because women are more likely to take time off for family, choose lower-paying specialties, and may work fewer hours than men. But JAMA found that even within the same specialty and adjusted for working hours and seniority, male doctors took home $12,000 more per year. Over the course of a 30-year career, this disparity costs women doctors a whopping $350,000!

So what is causing women to earn less? And what can be done about it?

1.     Women need to become better negotiators.

Women generally don’t feel comfortable asking for promotions or for more money from their employers, business partners or patients-and it could stem from a relative lack of confidence compared with their male peers.

Next: Passively accepting a 'no' answer is a common mistake

In their recent book, The Confidence Code: The Science and Art of Self-Assurance – What Women Should Know, journalists Claire Shipman and Katty Kay reveal that even the most accomplished women routinely underestimate their value and ability, and are more risk-averse than their male counterparts. A pervasive lack of confidence often holds women back.

This issue is not unique to American women. Nikki Stamp, MD, a cardiothoracic surgeon in Sydney, Australia, explained how her lack of confidence undermined her negotiation for a higher-paying position: “I asked to be employed as a fellow … but [the hospital] was not willing to fund the position. I just accepted the vague explanation at face value.”

Why are we wasting money on healthcare with poor outcomes?

Passively accepting a “no” answer is a common mistake for novice negotiators. And women are especially vulnerable. Women routinely accept the first salary they’re offered–not knowing thatit’s possible to negotiate for a higher one. One study showed that even with their first jobs, men are four times as likely as women to negotiate their starting salary. Men also make salary a priority. Male physicians, for instance, ranked “high pay” as their second-highest priority for job satisfaction while it ranked fourth for women.

To their own detriment, women often mistakenly negotiate based on what they need-since they are often married to another professional-instead of what they are worth. Worse yet, women hesitate to apply for positions for which they are well qualified, because they feel unworthy or not ready.

Stamp believes that doctors generally, and women doctors particularly, don’t develop the business or negotiating skills that could make them more financially independent. “One thing that works very much against women is that we do not talk about how much we earn,” she says.

Next: Don't rule out higher-paying specialties

Heather Yeo, MD, a surgical oncologist at New York-Presbyterian/Weill Cornell Medical Center, concurs. On the other hand, as a researcher she has had experience negotiating start-up packages. She’s observed that her male colleagues often negotiate for a higher stipend while she has opted to negotiate for perks that make her life easier-support in the form of a research assistant and statistician, for example-which to her are more valuable than money.

Young doctors are jumping ship to non-clinical roles

So even when women in medicine are negotiating, they are asking for different things than their male peers. These choices contribute to the wage gap without telling the whole story. Either way, she contends that women need to become more comfortable competing and taking career risks. As the vice chair of communications for the Association of Women Surgeons, she says that groups such as hers offer resources such as information on promotion and negotiation.

2.     Women doctors shouldn’t rule out higher-paying specialties and/or private practice.
 

Women doctors tend to cluster in lower-paying specialties–and often work in lower-paying hospital settings–two factors that contribute significantly to the income gap. Women often eschew higher-paying specialties because of the time commitment. For example, women currently comprise just 14% of plastic surgeons despite growing numbers of women receiving training in this specialty. Why?

Heather Furnas, MD, co-founder of Plastic Surgery Associates in Santa Rosa, California, explains: “The hours are long, the years of training are long, and it’s very difficult to have a child during the 15 or so years it takes to get through college, medical school, and training,” she says. “The money comes with potentially huge sacrifices … The training model is based on a man’s life, and there will need to be adjustments if women are to be able to have children as early as and as much as their male counterparts do.”

Next: Women can clock more billable hours

Furnas’ observations point to a Catch-22 in medicine: The culture in higher-paying specialties won’t change until more women enter, but the existing culture prevents more women from entering.

As with all decisions in life, women must consider potential trade-offs in choosing a demanding specialty. Many successful women doctors have had to ignore the naysayers (including the well-meaning advice of mentors, program directors, and even parents), and take risks, before ultimately achieving happiness in their (very demanding) fields.

3.     Women can clock more billable hours and increase services-per-patient ratios

Male doctors see more patients, on average, and provide more services per patient – which tends to increase their income. An astounding study of Medicare reimbursements by personal finance firm NerdWallet Health found “On average, male doctors are paid 88% more in annual Medicare reimbursements. Men make $118,782 per year from Medicare; women are paid $63,346.

·       Male physicians see 60% more patients. On average, women doctors treat 320 Medicare patients per year, while men treat 513 patients.

·       Male doctors make more money per patient treated.  On average, they make 24% more treating each patient than female doctors do.

• Male doctors pIerform more services per patient treated.  To explore this, NerdWallet Health devised a metric to calculate a physician’s average “service volume” per patient. They found that male doctors billed Medicare, on average, for one more procedure per patient than female physicians (5.7 services performed per patient by male doctors vs. 4.7 services per patient by female doctors).

• This gap in service volume is true across specialties. Male doctors performed more services per patient than female doctors across nearly all specialties. In a specialty like pathology – where doctors infrequently provide services directly to patients – they found no variation in average service volume.

Next: Lobbying for more transparency

Prior research has shown that male doctors generally work more hours, which could increase their billings to Medicare. Men also dominate high-paying surgical fields; women make up less than 10% of Medicare physicians in surgical specialties like cardiac, orthopedic, and neurosurgery.

Obviously, patients appreciate that their female doctors spend more time with them. But don’t assume that you have to sacrifice quality for quantity. Find ways to strike an efficient balance between patient care and your own bottom line.

4.     Women canlobby for more transparency and engage in peer networking

Women doctors can negotiate from a position of strength when they know what their peers earn. Greater transparency in income data could help reduce the pay gap. Currently, however, most doctors don’t know if they are being paid fairly since most institutions lack clear policies on how to determine salaries. Or worse, some institutions implement pay secrecy policies (which may be illegal).

Networking among peers can help women close the awareness gap. Find a mentor who is familiar with your unique skill set and your goals and who can advocate for you.

The American Medical Women’s Association is working to level the playing field for women in medicine through its Gender Equity Task Force. Its members educate and mentor women physicians and support networking through several events annually.

Next: Closing the wage gap

Conclusion

Women-in medicine as in other fields-leave money on the table for a variety of reasons, often as they attempt to prioritize home and family, and make compatible career choices. But choosing to prioritize your family shouldn’t disadvantage you in negotiations. Under-valuing your worth is always short-sighted. A layoff, divorce, death, or disability can quickly thrust any woman into the job of primary breadwinner in the family. A woman’s worth shouldn’t go up or down based on her husband’s take-home pay.

There are many reasons why a wage gap exists, and there are also actions women can take to help close it.

Karen Coyne, CFP(R), is a strategic wealth advisor with Raymond James in Hagerstown, Maryland. With over 15 years of experience, she helps physicians make smart financial decisions so they can focus on what they do best. Email karen.coyne@raymondjames.com.

12920 Conamar Dr, Suite 202, Hagerstown MD 21742

Tel. 301.739.7002

Raymond James Financial Services Inc., Member FINRA/SIPC. Any opinions are those of Karen Coyne and not necessarily those of Raymond James.

The information has been obtained from sources considered to be reliable, but we do not guarantee that the foregoing material is accurate or complete.