The Truth About the Gender Pay Gap in Health Care
Does equal pay for equal work exist among male and female medical doctors? Here are the facts
Women have been paid less than men ever since incomes were first recorded. In 2016, the World Economic Forum’s Global Gender Gap Report revealed that there is not one country where women are receiving equal pay for equal work. But despite decades of ample evidence, there is still widespread debate surrounding the existence of the gender pay gap.
Although the gender pay gap exists globally, we’ll focus on the pay gap as it exists in the United States, and more specifically, in health care.
Making sense of the statistics
As PayScale points out in their Inside the Gender Pay Gap report, there is an uncontrolled gender pay gap — the popularly referenced ‘women earn $0.76 for every dollar men earn’ statistic — and a controlled gender pay gap, which shows that women earn $0.98 for every dollar men earn. This controlled gender pay gap statistic covers all industries and takes into account factors such as job type, education, and experience, which allows us to compare men and women in similar career paths.
The difference between $0.76 and $0.98 reveals a more systemic problem — one of opportunity. The same report from PayScale reveals that men are significantly more likely than women to fill senior management positions — 85 percent to be exact — and 171 percent more likely to hold senior management positions throughout their career.
The pay gap inevitably varies by industry. According to a 2016 Glassdoor report, the adjusted (after applying statistical controls such as education and experience) pay gap is the most pronounced in health care, where men are on average paid 7.2 percent more than women. Among other industries with the highest adjusted pay gaps are insurance, mining and metals, transportation and logistics, and media.
The pay gap between male and female medical doctors can be as high as 37% in older age groups.
How doctors measure up
Medscape’s 2017 Physician Compensation Report similarly found that “female physicians consistently make less money than their male counterparts.” However, the results of Medscape’s report revealed significantly higher pay gaps than the 7.2 percent reported by Glassdoor. By age group, the pay gap between older male and female medical doctors is as high as 37 percent, and 18 percent for younger medical doctors. The fact that women are more likely to work part-time is not a contributing factor to this observed pay gap because Medscape’s report only analyzed data on full-time employees.
Medical Economics’ 88th annual Physician Report corroborates these findings. The 2016 results show that even though average income has steadily increased since 2011, female medical doctors are still earning an average of $66,000 less than male medical doctors. The bottom line, no matter how you crunch the numbers, is that women earn less than men.
Some specialties more promising than others
Some medical fields have narrowed the gender pay gap while others have widened it. Female specialists experience the most significant pay gap in the medical field at a stunning 37 percent; last year, that pay gap was 33 percent.
A recent study revealed that female ophthalmologists only earn $0.58 for every dollar earned by male ophthalmologists.
This backward trend is especially reflected in ophthalmology. An original investigation published in JAMA Ophthalmology — looking specifically at Centers for Medicare & Medicaid Services (CMS) reimbursement rates — revealed that female ophthalmologists earned $0.58 for every dollar earned by their male ophthalmologist counterparts. It is important to note that female ophthalmologists in this study also submitted fewer charges; a finding that can account for most of this gap in earnings. However, when researchers controlled for clinical activity, earnings were still lower for female ophthalmologists. Of the highest-earning ophthalmologists reviewed in the research study, only eight percent were women. This trend is particularly alarming given that during the same time period, the ophthalmology specialty saw a 12 percent overall growth in earnings.
The same trends are seen in academic medicine. A recent study published in JAMA, Internal Medicine revealed that in an analysis of over 10,000 medical doctors, female medical doctors on average made $51,515 less than male medical doctors; and with other variables (e.g., age, years of experience, clinical activity) accounted for, female medical doctors were still on average making $19,878 less than male medical doctors.
On a more positive note, this significant gender pay gap does not seem to exist across the board. Some medical schools report little to no income difference between their male and female employees. And while this isn’t necessarily a ‘win’, it’s still worth noting that according to Medscape’s 2017 report, the pay gap between male and female Primary Care Providers (PCPs) has dropped from 18.9 percent to 16 percent — a trend in the right direction.
How can we fix such a deep-seated issue?
A critical aspect of closing the pay gap is passing legislation that protects female employees’ wages and prevents employers from seeking retaliation when female employees take action to resolve a wage discrimination issue. Each state has specific laws in place to protect — or not protect — female employees against wage discrimination. Among those states who have relatively strong equal pay laws are California, Maryland, Massachusetts, Illinois, Minnesota, and Vermont. Among those states who have no equal pay laws are Mississippi and Alabama. Check out this state-by-state map for the full breakdown.
Beyond government legislation, there are more actionable solutions. Recognizing the implicit biases that women face is a huge step in the right direction. Historically, social norms have dictated that men are expected to negotiate their salary, yet women who attempt to negotiate their salary are flagged as too assertive.
As Dr. Vineet M. Arora points out in her well-known editorial, It Is Time for Equal Pay for Equal Work for Physicians — Paging Dr Ledbetter, “Regardless of a woman’s ability or desire to negotiate, there could be a bias against women, such that supervisors do not offer as much when hiring because they know that women will be less likely to negotiate.” Bringing awareness to these unconscious biases is an essential step toward equal pay.
For more on this topic — including strategies for combating unconscious biases in the workplace — see Recognizing Gender Bias in Your Practice
Dr. Arora’s suggestion for employers? Salary transparency. And according to Dr. Kim Templeton, president of the American Medical Women’s Association, keeping the gender pay gap discrepancy in the limelight will help fix the issue until the pay gap is closed completely. Reports from PayScale and other companies seem to support this tactic.
Female medical doctors can also look to groups such as The American Association of University Women (AAUW) who offer services to help women close their own gender pay gap as legislation lags behind, including salary negotiation workshops and strategic legal case support.
Here’s to hoping it won’t take 170 years to close the gap.