Co-authored by Blake Vessa and Kathleen Beebe, MD
Fifty years after the ratification of the Equal Pay Act by JFK in 1963, a gender wage gap still exists in the United States in most professional fields, including medicine. In 2009, the Los Angeles Times reported that women earned just 77 cents for every dollar that men earned. Many suggest that this is biased since women tend to gravitate towards lower-paying fields. Indeed, in medicine women tend to pursue lower-paying primary care specialties. However, a 2009 study that focused solely on the incomes of primary care physicians found that compared to white males, female peers of any race had lower incomes than their male counterparts, even after adjustments for differences in work effort, physician characteristics, and practice characteristics were made. There is ample evidence that shows that this wage gap is replicated within multiple specialties in the medical profession, including one surveying physician researchers and a 2011 study focused on physicians leaving residency programs in New York during 1999-2008. However, recent changes in the medical field, including the shifting gender ratio and the implementation of the Affordable Care Act, provide an impetus to change this gap in either direction.
Literature on the gender wage gap in medicine has been a popular topic of discussion in recent years and a myriad of research has been published discussing the evidence and explanations for this gap. For instance, it has been shown that women in dual-physician marriages are much more likely to sacrifice their careers in an effort to maintain their family's well-being. It is speculated that as women pause their careers for childbirth and childcare they face "the motherhood wage penalty": delays in training and promotion that may lead to lower wages. Moreover, women may choose lower-paying jobs or specialties with more flexible work schedules in order to balance their work and family life. Although these women are being paid less, they may be purposely seeking out employment arrangements that compensate them in other, non-financial ways, such as with on-site childcare, shorter commutes, and flexible schedules. At a minimum, previous reports have indicated that these factors play a role in pediatric residents' program selection and in women physicians' decision to leave academia. However, although motherhood is a common explanation for the wage gap, a JAMA study suggested that this was not a significant factor because both mothers and women without children experienced comparably lower pay than men. Besides marriage and child-rearing, the 'pipeline effect,' which is based on the premise that there are an insufficient amount of women that have been in academia long enough to warrant reaching higher ranks has been cited as a reason for rank and pay inequalities. This theory is suggested by the decreasing percentage of women as the academic rank increases.
There are also more subtle social constructs that may contribute to differing wages. These include the inherent quality of self-rated IQ hubris among males and the relative humility effect among females. Social roles and expectations also may play a role in negotiation of salaries. A study of students graduating from Carnegie Mellon found that 57% of males negotiated for a higher starting salary than had been offered, compared to just 7% of females. As a result, starting salaries of men were 7.6% (almost $4,000) higher than those of women. Those that negotiated, whether male or female, were successful in increasing their starting salary by 7.4%, or $4,053 - almost exactly the difference between men and women's average starting pay. This correlation strongly suggests that the salary differences between men and women might have been eliminated if more women had negotiated their offers.1
Women comprised 50.8% of the medical school applicant pool and 49.6% of medical school matriculates in 2003, and though the percentage of all female applicants and matriculates has declined slightly since then, the gender splits remain near 50/50. Furthermore, an exodus of male physicians from primary care has been synonymous with a growing proportion of female physicians, who disproportionately choose primary care. Since 1996-97, there has been a 40% increase in the female primary care physician supply and 16% decline in the male primary care physician supply. This increase in the number of female primary care physicians corresponds to an increase in the total female medical school matriculates, compounding the effect. The shifting gender ratio in primary care and the growing demand for primary care physicians as a result of the Affordable Care Act has great potential to minimize the gender distinctions in the incomes of primary care physicians, if women are able to negotiate for fair and equal pay.
However, its narrowing effect on the gender wage gap will not extend into the more competitive specialties and subspecialties that male physicians still dominate if women continue to gravitate away from these areas. There, gender distinctions may persist as a result of the aforementioned 'pipeline effect' in which case factors limiting women's entrance into the pipeline need to be overcome.
Bernstein et al. found that the addition of a required medical school course in musculoskeletal medicine would increase application rates to orthopaedic surgery in both genders, but the effect on female students was more than six times as large as the effect on male students. Furthermore, a survey by Neumayer et al. showed that female medical students were more likely to choose general surgery as a career when there was a higher proportion of women on the surgical faculty. These conclusions suggest that by altering medical school curriculum to be more specialized, we may be able to overcome the 'pipeline effect,' which currently results in more women in lower paying fields and contributes to the gender wage gap. Furthermore, as more women achieve higher ranks in medicine, a positive feedback loop may be initiated, further eliminating the 'pipeline effect' and closing the gap.
Moving forward, the most plausible course of action to achieve closure in the gender wage gap in medicine is for women to compete with men for the higher-paying specialties and subspecialties and to advocate for equal wages in these fields. A diminished wage gap within primary care may also occur as an increase percentage of women in the field may minimize the gender distinctions in salary. The gender wage gap in medicine is multi-dimensional and should be addressed within specialties as well as in medicine as a whole.
Footnotes
1. Babcock, L. (2003). Women Don't Ask: Negotiation and the Gender Divide. Princeton, NJ: Princeton University Press.