In July, newly graduated physicians across the country begin residency training, while others finish and begin their careers. At the same time, headlines continue to warn of the burnout medical professionals must endure as the COVID-19 pandemic enters its third year.
During this transition period for newly appointed physicians and specialists, it is worth highlighting some ongoing challenges specific to the women who make up more than a third of the physician workforce. We know that women in all occupations earn about 15% to 20% less than men. In the medical field, female doctors have been paid almost 30% less. Data from academic medicine also shows particularly large differences for women of color, with black and Latina women earning much less despite having similar education to their white male counterparts. In general, the gender pay gap in medicine today looks more like a gulf.
Attempts to explain away this intractable problem among physicians are numerous. Cultural narratives attributing inequality to women who work part-time and take time off to raise families are just two examples. Yet these arguments are flawed, as research has shown that women still fall short when controlling for factors such as specialty, experience, and research productivity.
The American Association of Medical Colleges has published statistics that break down salaries in academic medicine by faculty rank and gender. At each rank, there were gender gaps in pay. In the past, when women were in the minority in the medical field, the gap was explained by pipeline problems – women just didn’t sit at the table long enough. Now, with women making up more than half of all medical school classes, salaries should be well on their way to parity. Yet progress is at a standstill at best.
A recent study showed that these pay gaps are costly: The inequality in hiring salaries, followed by ongoing pay inequality, can lead to an income difference of an estimated $2 million over the course of a career in medicine. This disparity reportedly begins early in a physician’s career and widens over a decade. In a profession where length of school and residency means that many doctors do not fully enter the market until they reach their 30s, this is unscrupulous. In addition, the median education debt for those who graduated medical school with debt was $200,000 in 2019. After years of deferred income due to paying off that debt, the number of full earning years until retirement is short. Each of them counts in the calculus.
By all accounts, the pandemic has not only widened the pay gap, but also the responsibility gap. Female doctors – like many women – have not only fulfilled their duties at work, but have also taken on a disproportionate amount of work on the home front, caring for children or elderly parents and the bulk of home schooling.
Meanwhile, academic progress for physicians is measured by publications and national lectures, yet many women have curbed academic productivity due to pandemic-related time constraints, and some have left academic medicine altogether. This could translate into an epidemic of failed progress up the academic ladder that hinders many women’s careers.
A fundamental question is whether this is an equity issue or a return on investment issue. With women making up such a large proportion of medical school classes and some 40% of full-time academic physicians, it seems to be both. Perhaps the solution lies in rephrasing the question: would a rational CEO want half of his employees not to live up to their potential? To what extent do unequal pay and being consistently undervalued contribute to burnout or the tipping point toward leaving the pipeline? What does this ultimately mean for patient care?
What are the solutions? Not surprisingly, knowledge is essential, and pay transparency is a concrete way to make progress in closing the gender pay gap. It can also provide a pathway to a legal remedy, should the need arise. Understandably, there is a lot of resistance to reward disclosure, especially as inequality continues. Yet departmental initiatives to equalize pay can be started from the bottom up by the faculty or from the top down by the department chair of a medical school, or in a systematic way from a university, hospital or practice. At the same time, standardized compensation packages for first hires by rank are easy to set up and defend. And national medical organizations must not only take a stand, they must also drive change by supporting equal pay legislation and by continuously and strategically advocating for equal pay.
In medicine, we collect data to make logical decisions and effect change. In this case, it’s not going to act on the overwhelming data we have against us as doctors. At a time when healthcare is still reeling from the effects of the pandemic and there is a threat of a shortage of doctors, we cannot afford not to pay female doctors equally.
Next year, when National Women’s Doctors Day rolls around in February and National Doctors Day in March, please spare the fanfare and give us what we really want: equal pay for equal work.