In July, newly graduating physicians from across the country will begin residency while others complete and begin their careers. At the same time, headlines continue to warn of burnout experienced by healthcare professionals as the COVID-19 pandemic enters its third year.
During this transition period for new physicians and specialists, it is worth highlighting some ongoing challenges specific to women who make up more than a third of the physician workforce. We know that in all professions, women are paid about 15 to 20% less than men. In the medical field, female doctors were paid almost 30% less. Data from academic medicine also shows particularly large gaps for women of color, with black and Latina women earning significantly less despite similar training to their white male counterparts. Overall, the gender pay gap in medicine looks more like a chasm these days.
Attempts to explain this persistent problem among physicians are numerous. Cultural narratives attributing the disparity to women working part-time and taking time to raise families are just two examples. Yet these arguments are flawed because research has shown that when we control for factors such as specialty, experience, and research productivity, women still fall short.
The American Association of Medical Colleges has released statistics breaking down academic medicine salaries by faculty rank and gender. At each rank, there have been gender pay gaps. In the past, when women were in the minority in the medical field, the gap was explained by pipeline issues – women simply hadn’t been at the table long enough. Now that women make up more than half of all medical school classes, salaries should be on track to reach parity. Yet progress has stalled, at best.
A recent study has shown that these pay gaps are costly: starting wage inequality, followed by ongoing wage inequality, can lead to an estimated $2 million difference in earnings over a career in medicine. This disparity would start early in a doctor’s career and widen for a decade. In a profession where the length of study and residency means that many physicians do not fully enter the market until they are in their thirties, this is unconscionable. Additionally, the median college debt of indebted medical graduates was $200,000 in 2019. After years of deferred income due to the repayment of this debt, the number of years of full earnings until retirement is short. Each of them counts in the calculation.
By all accounts, the pandemic has widened not only the wage divide, but also the responsibility divide. Female doctors – like many other women – not only fulfilled their duties at work, but also took on a disproportionate amount of work at home caring for children or elderly parents and doing the lion’s share home schooling.
Meanwhile, doctors’ academic progress is measured by national publications and conferences, but many women have curtailed their academic productivity due to pandemic-related time demands, and some have left academic medicine altogether. This can result in an epidemic of failed progression along the academic ladder that hampers the careers of many women.
A fundamental question is whether this is an equity issue or an ROI issue. Now that women make up such a large portion of medical school classes and some 40% of full-time academic doctors, it seems to be both. The solution may lie in reframing the problem: would a rational CEO want half of his employees not living up to their potential? How much does unequal pay and being consistently undervalued contribute to burnout or tip the scales toward exiting the pipeline? How does this ultimately affect patient care?
What are the solutions ? Unsurprisingly, knowledge is key and pay transparency is a concrete way to make progress in closing the gender pay gap. It can also provide a pathway to legal recourse if needed. Naturally, there is a lot of resistance to revealing wages, especially as long as inequalities persist. Yet departmental initiatives to equalize salaries can be initiated “bottom-up” by the faculty or “top-down” by the chair of the department of a medical school, or of an entire university. , a hospital or a practice in a systematic way. At the same time, standardized pay packages for first-time hires by grade are easy to institute and defend. And national medical organizations must not only take a stand, they must also lead change by supporting equal pay legislation and continuously and strategically advocating for equal pay.
In medicine, we collect data to make logical decisions and make changes. In this case, not acting on the overwhelming data we have goes against our grain as doctors. At a time when healthcare is still reeling from the effects of the pandemic and doctor shortages are looming, we cannot afford not to compensate female doctors the same.
Next year, when National Women Doctors Day is in February and National Doctors Day is in March, save the fanfare and give us what we really want: equal pay for equal work.