February 4, 2011 — For women physicians, equal work may not necessarily translate into equal pay, according to an article published in the February issue of Health Affairs.

Male physicians fresh from residency training programs in the state of New York earned $16,819 more in starting salaries than their female counterparts in 2008, according to the study authors. They calculated this pay differential after controlling for variables such as medical specialty, patient care hours, practice type, location, and physician age. This compensation gap was greater than it was in 1999, when men outearned women by $3600.

Such an unexplained salary trend seems to fly in the face of the numerical strength that women are slowly achieving in medicine. After all, they account for almost half of all medical students and roughly 30% of all practicing physicians — a far cry from the situation 50 years ago, when professional literature still referred to physicians as “medical men.”

In casting about for possible explanations for the widening compensation gap, lead author Anthony Lo Sasso, PhD, and colleagues are reluctant to cite a rise in gender discrimination, which they call “difficult to believe.” Instead, they hypothesize that women physicians are settling for lower compensation in exchange for more flexible, family-friendly working conditions.

In contrast, leaders of the American Medical Women’s Association (AMWA) contend the gender bias is the likely reason why female physicians are paid less.

“The problem [of discrimination] hasn’t gone away,” internist and AMWA President Eliza Lo Chin, MD, told Medscape Medical News. “The gender equity gap is not closing. There’s a lot of work to be done.”

“It’s Hard to Swallow That Gender Bias Is Growing”

The study was based on survey data from roughly 8000 physicians who exited residency and fellowship programs in New York and took patient care positions from 1999 through 2008. Because all the physicians were coming straight out of the training gate onto the employment track, the researchers could avoid confounding variables such as experience, rank within an institution, and on-the-job productivity.

Before adjustments were made for other factors such as hours worked or specialty, starting salaries in 1999 were $173,400 for male physicians vs $151,600 for female physicians. The gap was larger in 2008, when starting salaries were $209,300 vs $174,000, respectively.

When unadjusted starting salaries for the entire 9-year period were analyzed together, the gender differential surfaced in nearly every specialty; for example, men earned 6% more in both family practice and emergency medicine, and 11% more in cardiology.

The differential persisted after the authors adjusted starting salaries for specialty and other variables such as patient care hours per week, which were especially important to factor out because women physicians are more likely to work shorter work weeks than men.

In an interview with Medscape Medical News, Dr. Lo Sasso said his research team could not rule out gender bias as a source of the adjusted differential. However, they shy away from it as an explanation.

“It’s hard to swallow that gender bias is growing,” said Dr. Lo Sasso, a professor of health policy and administration at the University of Illinois–Chicago.

Similarly, Dr. Lo Sasso said his team was not willing to accept that women physicians have become worse negotiators. “It’s hard to swallow that they’ve gotten worse to the tune of almost $17,000,” he said.

A more likely hypothesis — which study data can neither prove or disprove — is that women physicians “are disproportionately willing to give up some salary for greater job flexibility,” according to Dr. Lo Sasso. “This is what we speculate.” That flexibility, he said, can amount to not having to take hospital call shifts or work evenings and weekends.

Group practices and hospitals that hire new physicians, he noted, “need to become more attuned to quality-of-life issues,” particularly as they attempt to grow a workforce commensurate to the demands of the Affordable Care Act, which will extend insurance coverage to 30 million more Americans.

Getting Women “For Less”

To AMWA’s leaders, the gender pay gap of $16,819 uncovered in the Health Affairs study is linked to discrimination, plain and simple.

Roberta Gebhard, DO, a member of the AMWA board of directors and cochair of the group’s gender equity task force, said unequal pay is indicative of a profession where women account for only 12% of medical school deans and chairs and are less likely to be promoted than men. Dr. Gebhard and Linda Brodsky, MD, the other cochair of the gender equity task force, both said that medical organizations make no secret of their ability to “get women for less.”

Dr. Brodsky agrees that employers indeed tout flexible, family-friendly work arrangements to women physicians. “But women give away more…than they need to give away,” she said. “They have to be very careful.”

To make matters worse, female physicians who try to negotiate bigger paychecks often lose ground because employers view them through gender-stereotypical glasses as being too “demanding,” said Dr. Brodsky. Dr. Gebhard, a hospitalist, noted that she pulled down a better salary after she hired a man to negotiate on her behalf.

“There was no [gender] baggage when he negotiated,” she said.

Strong Demand Reducing Gender Distinctions, Says Recruiter

A different take on gender discrimination comes from the head of a physician recruitment group called Merritt Hawkins, which helps place newly minted physicians with employers.

“I really don’t see it on a daily basis,” said Merritt Hawkins President Mark Smith. “The demand for physicians is so strong now that [gender] distinctions are getting erased or minimized.”

In one odd way, the growing percentage of physicians who are women has worked to reverse compensation advantages that some once enjoyed, according to Smith. A few years back, when women physicians were less commonplace, he said, some employers would pay a premium in terms of salary to recruit one.

“You still see it a little in obstetrics-gynecology, but not quite so much in other specialties, because the supply has increased,” said Smith.

Health Affairs. 2011;30:193-201. Abstract