Closing the Gender Pay Gap in Medicine

A recent editorial in The New England Journal of Medicine highlighted something that really has been a running sore in medicine from many decades: the fact women physicians are paid on average about 75% of what men are paid for doing the same work. Our gender pay gap is actually one of the worst in any industry. There are some hoary, old, handwaving justifications for this. The usual suspects are that women often go to part-time to have and raise a family and that women tend to select specialties, such as my own of pediatrics, that rank among the lowest-paying specialties. The big bucks are to be found in procedural specialties, but also radiology and ophthalmology (even if not doing eye surgery). Yet research shows even when adjusting for confounders like this, a women physician is still paid less for doing the exact same thing as a man. The editorial discusses the many reasons for this. Left undiscussed, perhaps it’s kind of a third rail in this issue, is plain, old-fashioned misogyny. This does play some role now, and certainly did in the past. My own physician father, although excellent in many ways, used to make disparaging comments about “hen medics.” But he was a product of his times — 1940s through 1970s — and if he were alive now I hope his attitudes would be different.

One issue is the tendency of many women not to be hard-nosed negotiators. This is lose/lose for them. A man who does that is often expected, even applauded for it; a women can actually be downgraded for it.

Women are subject to a likability standard that men exhibiting similar behaviors are not. The prevailing cultural narrative that women are less skilled negotiators than men is too simplistic and contradicts decades of experimental research. In fact, women do negotiate, but when they do, they tend to be viewed as less hireable. 

Other stereotypes, pervasive throughout the workplace in many industries, show themselves in medicine, too:

Long-standing cultural expectations regarding women’s behavior remain at odds with well-accepted traits of leaders and high performers, even though organizations with female leaders often outperform those with male leaders. Women in the workplace are expected to be both directive and participative, decisive and caring, and executive and approachable, and they face backlash when their behavior violates these stereotypes. 

If you asked any department chair if he (overwhelmingly he) believes in equal pay for equal work, I am certain he would say “of course,” and possibly even resent you asking the question. Yet there are subtle and not so subtle ways inequality develops. One is women physicians tend to be shut out of the pipeline that leads to leadership, and thus higher paying positions. With many fewer women in leadership positions, there is a lack of role models for young women physicians. Now I have certainly seen male physicians who are exemplary mentors for women, but there is no question it would help if we had more women in leadership positions, especially in specialties traditionally dominated by men, such as all types of surgery.

Interestingly, there is a substantial literature showing women physicians, when compared nose to nose with male counterparts, actually provide better care — more thorough with better outcomes. Part of this is research shows women physicians tend to spend more time with patients. It’s not surprising outcomes are better. But of course in a pay scale system based, as many are, on “productivity,” or how many patients you see, women’s income suffers from spending more time on each patient. The authors summarize this way:

To close the pay gap in medicine, institutional leaders and their colleagues in human resources and finance will need to scrutinize basic assumptions underlying compensation methods to understand the expectations and outcomes they generate, create new approaches that better account for women’s traditional contributions and related biases, and track and report gender metrics at all compensation touch points, especially in initial hiring.

Half of all medical students are now women, a gratifying evolution from my father’s era, when only 5-8% were. Our profession needs to deal with this inequality now. It’s gone on far too long.