Monday, July 18, 2016

Surprise! Female physicians are paid less.

I am sure many of you have seen this recently published article about physician wage gender disparity in the New York Times. The original research article was published in JAMA Internal Medicine, and received a lot of popular press with mentions in the New York Times, Time magazine, Boston globe, Marie Claire and many others. I am always a little wary of science/research reporting. I sometimes try to read the primary research paper behind the news item, especially if the topic interests me. Pay equity for physicians is certainly a topic of interest for me.

This article put a specific number on the gender pay disparity: female physicians make roughly $20,000 per year less than male physicians. This is after adjusting for age, experience, faculty rank, specialty, scientific authorship, NIH funding, clinical trial participation, and Medicare reimbursements. This news came up in a non-work context with a male resident physician. He told me that the problem with these types of studies was that they don't account for the amount of work put in. According to him, "female physicians work less than male physicians". Well how do you mean sir? Do you mean more female physicians work part time? He said, "In my experience, women complain more and work less, period. They always have to go pick up their kids or some other excuse and they dump their work on me". Ugh! Alright then Dr. Curmudgeon.

The paper is well written and the research is pretty well done, I highly recommend reading. Sad statement, but female physicians being paid less won't come as a big surprise to anyone. Safe to say, I was being ironic in the blog post title. Gender based pay disparity occurs in the rest of the US workforce. The dicey question, which Dr. Curmudgeon raised, is the pay disparity unfair? It maybe unfair from a social standpoint. Women ending up with more childcare or household responsibility and not being able to match male productivity. But is it unfair from an economic standpoint? Are they truly being paid unequal amount for equal work? Is there is an inherent bias towards them? This paper suggests that there maybe a component of both social and economic unfairness.

Comparing unadjusted salaries, i.e. without taking into account specialty, faculty rank etc., the difference is even larger, $51,000 per year. It may be true that more women than men make choices that lead to being paid less, such as working in certain specialties or working part time. But women don't choose to be overtly discriminated against. The authors adjusted for a lot of factors that could explain the pay disparity and still found a gap of roughly $20,000. The authors lacked some information, most importantly, full time vs part time status. They did two things to counteract that. One, they used Medicare reimbursement in their multivariate analysis to adjust for clinical volume. Two, they eliminated bottom 25th percentile of income data, with the assumption that it would eliminate part-time workers from analysis. They are imperfect measures, but the best that could be done with the lack of available information.

I am pretty early in my training, and from my own limited experience, I do believe that there is at least some inherent bias. Dr. Curmudgeon is not an exception, there are more people like him inhabiting the medicine world. They may be outspoken about their biases, or maybe not, or maybe only in certain contexts. They may be aware of their biases, or maybe not. I suspect, a lot of Dr. Curmudgeons are even in positions where they can influence factors, like promotions and pays. If you have encountered one of these Dr. Curmudgeons, I'd be interested in hearing your stories in comments.


  1. Women's choices are not made in a vacuum. If you never see a woman as an attending in a highly-paid interventional specialty, you're less likely to think of yourself there. If you do see a lot of macho posturing about how hard they work and how little they sleep, you might not think it's a good fit. So you "choose" a more "family-friendly" specialty, and then you have a nice boss who knows you have little kids and assumes you won't want the promotion/committee position/opportunity to write a grant, so you don't get the opportunities. And maybe you're married to a guy who did go into the higher-earning, work-all-the-time interventional field (or is jockeying for partner in a law firm or running a hedge fund) and the nanny quits, or the kids are sick all the time in daycare, and you're doing all the primary parenting stuff anyway and it's exhausting, so you "choose" to cut back to part-time or stay home, which then justifies the next round of not offering promotions or opportunities to women.

    I've run into a whole series of Dr. Curmudgeons, starting with the anesthesiologist who asked my why my husband was allowing me to go into IM. Well, actually starting with my grandfather, who told me I shouldn't be an internist because my primary responsibility would be as a wife and a mother (I'd been married about six weeks at the time.) Then there was the med school classmate who said my chosen residency was a good place for women because "they don't care if you take medicine seriously or not." I'd go on, but I need a drink.

  2. I had similar thoughts on so called choices, you put it so eloquently. It's true, you can't be what you can't see. And as you mentioned, it is self-perpetuating. There were certainly specialties I rotated through with very few women in attending or resident positions and plenty of machismo. It didn't feel like a good fit to me, making it less likely that me or other people like me would "choose" that specialty. You also put the "choice" involved in being the primary parent and subsequent "choices" of leaning out well.

    The research article was interesting that even after accounting for the so called choices, there is still a difference. Is that difference due to institutional bias or women not negotiating? If you read the online commentary (for instance the comments here, there are lot of people who believe that the latter explains it, and that women "choose" to not negotiate for the money. Choose in quotes because studies ( have shown that women are often penalized more for negotiating harder.

  3. I'll never forget the male resident that called my maternity leave extra vacation. Feel sorry for his wife. I think I make a shitload more than he does right now, money wise.

  4. I do love when people think of maternity leave as vacation. As if recovering your body from birthing a child and caring for that child at the same time is pretty much the same as chilling on a beach.

  5. Our system pays on RVUs which are the same for all in the specialty. There's no bonus or salary negotiation. So, in theory men and women should be paid equally. But I suspect that women could be more prone to under code (by social norm of men overvaluing what they do and women undervaluing it). Also, I could see the Number of patients seen her hour be less for female providers, I personally tend to spend more time in the room. My male partners see patients faster, and also see more male patients who are less likely to be chatty. Female patients are significantly higher maintenance/time consuming than the average male patient - so more time to spend on non-billable care.

  6. In 2009 while doing a med student elective away, the anesthesiologist told me to my face that he would never be in a call group with women because "they just want to work a 0.6 or 0.8 or something".


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