This July, newly graduated doctors across the country will start their residency training while others will be finishing and beginning their careers. At the same time, headlines continue to warn of the burnout endured by medical professionals as the COVID-19 pandemic drags into its third year.
During this period of transition for newly minted physicians and specialists, it's worth emphasizing some ongoing challenges specific to the women who make up more than a third of the physician workforce. We know that across all professions, women are paid roughly 15% to 20% less than men. In the medical field, women physicians have been paid close to 30% less. Data from within academic medicine also shows particularly large gaps for women of color, with Black and Latina women making far less despite undergoing similar training as their white male counterparts. Overall, the gender pay gap in medicine is looking more like a chasm these days.
Attempts to explain away this persistent problem among physicians are plentiful. Cultural narratives attributing the disparity to women working part time and taking time off to raise families are just two examples. Yet these arguments are flawed, as research has shown that when we control for factors including specialty, experience and research productivity, women still come up short.
The American Association of Medical Colleges has published statistics breaking down salaries in academic medicine by faculty rank and gender. At every rank, there have been gender gaps in pay. In the past, when women were in the minority in the medical field, the gap was explained away by pipeline issues – women just hadn’t been at the table long enough. Now, with women comprising over half of all medical school classes, salaries should be well along the way to parity. Yet progress has been halting at best.
A recent study showed that these pay gaps are costly: The inequality in hiring salaries, followed by ongoing salary inequality, can lead to an estimated $2 million difference in earnings over the course of a career in medicine. This disparity reportedly starts early in a physician’s career and widens for a decade. In a profession where the length of school and residency mean many physicians don’t fully enter the marketplace until they’ve reached their 30s, this is unconscionable. In addition, the median education debt for those graduating 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 one of them counts in the calculus.
By all accounts, the pandemic widened not just the salary divide but the responsibility divide. Women physicians – like many other women – not only have fulfilled their duties at work, but also have shouldered a disproportionate amount of work on the homefront caring for children or elderly parents, and doing the lion’s share of home schooling.
Meanwhile, academic progress for physicians is measured by publications and national lectures, yet many women curbed their academic productivity due to pandemic-related demands on their time, and some have left academic medicine altogether. This may translate to 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 a return-on-investment issue. Now that women make up such a large portion of medical school classes and some 40% of full-time academic physicians, it seems to be both. Perhaps the solution lies in reframing the issue: Would any rational CEO want half of their workers not to live up to their potential? To what degree do unequal pay and being consistently undervalued contribute to burnout or tip the calculus toward leaving the pipeline? How does this ultimately affect patient care?
What are the solutions? Not surprisingly, knowledge is key, and pay transparency is a concrete way to make strides forward in closing the gender pay gap. It can also offer a path to a legal remedy should the need arise. Understandably, there is plenty of resistance to revealing pay, especially while inequity persists. 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 at a medical school, or from across a university, hospital or practice in a systematic manner. At the same time, standardized pay packages for initial hires by rank are easy to institute and to defend. And national medical organizations not only must take a stand, they also must drive change home by supporting equal pay legislation and by continually and strategically advocating for equal pay.
In medicine, we gather data to make logical decisions and to effect change. In this case, not acting on the overwhelming data we have goes against our grain as physicians. At a time when health care is still reeling from the effects of the pandemic and physician shortages are looming, we can’t afford not to pay women physicians equally.
Next year, when National Women Physicians Day rolls around in February and National Doctors Day comes in March, please spare the fanfare and give us what we really want: equal pay for equal work.