The gender pay gap in medicine

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not UBM / Medical Economics.

Recent research published in the Postgraduate Medical Journal using a sample size of 246,995 physicians revealed an $18,677.23 adjusted differential income between female and male doctors, after adjusting for “how hard the physicians worked, productivity, and level of experience.”

The gender pay gap in medicine and in the wider professional world has been discussed in the news recently. Physician income is dependent on a number of factors. There are many specialties, with sub-specialty certifications, regional differences in reimbursement, and diverse practice settings. Within a specific practice setting, qualifications, varied categories of patient visits and procedures, and number of years of work can impact on a physician’s salary. The concern that gender also factors into the equation has been difficult to confirm objectively. 

Several doctors shared their personal experiences with what they saw to be obvious gender pay gap discrepancies. A pediatrician in the Midwest that wishes to remain anonymous says that she happened to see the pay stub of male a colleague who had similar education, experience and worked the same number of hours as she did for more pay. She addressed the issue with her employers, who reprimanded her by saying, “You should not be discussing others’ pay rates.”  

Finally, when pressed, her employer explained the situation by stating, “He is being paid more because he was hired after you.” She offers advice to physicians that she wishes she had used early in her negotiation process. “State clearly that even though money is not the most important thing you look at in a job offer, you expect it to be a fair offer,” she says. Defining fair, however, is a challenge, as the response of her own employer illustrates.  

An OB/GYN in California experienced a pay gap that she believes was based on gender. 

“I was offered $50,000 per year lower than a male physician who was hired six months before me,” she says. Her colleague told her his starting salary and that they were equivalent in terms of experience, but she had an additional board certification. 

When she asked her employer, a large healthcare system, to match his salary, they would not. 

“I could have made a bigger deal about gender discrimination, but I live in a small town and wanted to get a job here, so I accepted the job with some resentment about this issue,” she says, wishing to remain anonymous. “I don’t think the problem lies with the physician, and it won’t improve unless employers are held to transparency in physician salaries,” she says. She also suggests that the idea of a physician union similar to the nursing union needs to be considered to try to address some of these gaps.  The question of whether physicians who are paid better than average would support such a union arises, however. 

Several physicians who hire doctors have made an effort to avoid gender-based differences in pay. Ian Leber, MD, CEO of Emergency Medical Associates of Tampa Bay, regularly makes job offers to physicians and has hired an almost equal number of men and women during his tenure. He currently uses a standard compensation package that is based solely on clinical productivity, but in previous roles, he took part in contract negotiations that were more flexible. 

“Though I never observed a situation where a male was offered a more generous package then a woman, I did commonly see that men were more likely to negotiate for higher compensation or additional benefits, where women seemed to be more likely to accept the initial offer,” Leber says. 

He explains that most employers expect a physician to float a counter offer and will have no animosity toward a physician for countering their offer. He suggests that doctors remain respectful during the negotiation stage and don’t issue ultimatums. However, he is mindful of deal breakers, such as vacation time and on-call responsibilities and advises physicians to think about priorities in requests in terms of must-have versus like-to-have. “I would also suggest declaring these deal-breakers as soon as compensation starts being discussed,” Leber says.

Kate Tulenko MD, a pediatrician and CEO of Corvus Health, a global health workforce firm, frequently offers positions to physicians on behalf of hospitals and clinics around the world. Like Leber, Tulenko has also observed that men are more likely to negotiate, while women frequently accept the first offer. She has been concerned enough to try and figure out why this happens, and she has come to the conclusion that women are not the cause of their own lack of effective negotiation. 

“There is evidence for why this happens,” she says. Tulenko cites a National Bureau of Economic Research publication that shows that women are penalized for negotiating, and adds that the solution to the gender pay gap lies with the employer, not with women. Tulenko has also noted that when women are asked about their previous income, the gender pay disparity can become a legacy if employers’ offers are correlated with previous income. Tulenko is dedicated to fair pay, and her company uses an algorithm to determine physician compensation as a way to help avoid unintentional gender bias and other types of bias from an employer or from a physician. 

Recent data suggests that when women comprise a large percentage of the workforce of any profession, the overall valuation of the work, and the income of the whole profession’s workforce, declines. The devaluing of women devalues the work of all physicians, and men and women physicians all stand to lose if women doctors are not compensated fairly. 

Dr. Moawad is a neurologist dedicated to patient empowerment as a way to improve health and wellness. Dr. Moawad is the author of Careers Beyond Clinical Medicine, a book for physicians and health care providers who want to learn about the many career options in healthcare. Dr. Moawad provides career information and resources for physicians and health care providers on her website, nonclinicaldoctors.com.