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September 5, 2018

Female physicians do not work as hard': The all-too-common belief behind one Texas doctor's controversial claim

Daily Briefing

    Read Advisory Board's take on this story

    A Texas physician apologized in a statement Sunday after saying that female physicians are paid less than men because they "don't work as hard" and prioritize "family, social, [or] whatever" responsibilities. His remarks sparked outrage, but some providers say such opinions are widely held and should be debated openly.

    Physician's comments spark outrage

    The comments by Gary Tigges, an internist at Plano Internal Medicine Associates in Plano, Texas, were published in the Dallas Medical Journal's September edition, which asked industry members to discuss what they thought about gender pay gap and possible solutions.

    Tigges' published comments stated, "Yes, there is a pay gap," adding, "Nothing needs to be 'done' about this unless female physicians actually want to work harder and put in the hours." He wrote, "Female physicians do not work as hard and do not see as many patients as male physicians. This is because they choose to, or they simply don't want to be rushed, or they don't want to work the long hours." He added, "Most of the time, their priority is something else. Family, social, whatever." 

    The comments sparked immediate outrage of social media. Several physicians, including both male and female doctors, have denounced Tigges' comments as "sexist and ignorant," the Washington Post's "To Your Health" reports. According to USA Today, Tigges has deleted his Twitter account, and the website for his practice is no longer accessible.

    Tigges apologizes

    Tigges on Sunday apologized for his original statements, saying they were taken out of context and that he was not aware they would be published. He said, "I have heard from several trusted female physician colleagues who disagree with and are deeply hurt and offended by the comments. I sincerely apologize to all female physicians for my comments and the pain they have caused."

    Tigges said he based his comments on data suggesting female physicians worked fewer shifts and saw fewer patients—which would result in less pay for female physicians.

    He continued, "My response sounds terrible and horrible and doesn't reflect what I was really trying to say. I'm not saying female physicians should be paid less, but they earn less because of other factors."

    Doctor's comments bring to light gender pay gap disparities

    Gabriela Zandomeni, a Dallas physician and the chair of the committee that publishes the Dallas Medical Journal, in a statement Saturday said the Dallas Medical Journal's committee decided to publish Tigges' comments because his opinion is not unique and should be publicly addressed.

    The Dallas Medical Journal has asked readers for their reactions to the opinions shared on the gender pay gap and, next month, it will publish a "representative sample" (Telford, "To Your Health," Washington Post, 9/3; Guynn, USA Today, 9/2).

    Advisory Board's take

    Veena Lanka, MD, Senior Director

    While this particular incident will likely be quickly forgotten, it's important not to overlook the larger issue that it illuminates: The gender pay gap in medicine is real—and growing.

    As Medscape's 2018 Physician Compensation Report indicates, male primary care physicians earn 18% more than their female peers (up from 16% in 2017), while male specialists earn 36% more than their female peers (up from 33% in 2016).

    “Do those differences really justify lower pay? Not quite, because higher volume does not automatically indicate higher quality.”

    Part of this gap is indeed due to the fact that female physicians do see fewer patients and work fewer hours on average. But do those differences really justify lower pay? Not quite, because higher volume does not automatically indicate higher quality.

    In a world where health care is shifting from volumes to value, patients treated by female doctors have consistently better health outcomes. Indeed, a 2017 JAMA study estimated that 32,000 fewer Medicare patients would die per year if male physicians achieved the same health outcomes as female physicians. Furthermore, as my colleague Megan Tooley explained recently, female physicians are often quite literally lifesavers for female patients—who often are marginalized in the current medical system.

    This doctor is not the only one harboring discriminatory views. According to a survey in JAMA, 66.3% of female physicians reported having experienced workplace gender discrimination. And such views continue to fuel the gender pay gap, as female physicians may be denied growth and leadership opportunities offered to their male peers.

    To really fix this gap, we have to understand why female doctors generally work fewer hours. The biggest reason is because they handle greater responsibilities at home—an average of 8.5 more hours per week, even after adjusting for age, experience, specialty, clinical revenue, and research productivity. These responsibilities can be temporary—such as pregnancy, childbirth and breastfeeding—or longer-term, such as being the primary caregiver for a family member. In the case of these shorter-term demands, female physicians often have to face burdens that their male counterparts don't, such as:

    • a lack of maternity leave that disproportionately affects women due to greater biological recovery needs; and
    • a lack of flexibility in their workday or workplace for breastfeeding and pumping. (That's particularly ironic given that most U.S. providers are striving to increase breastfeeding rates!)

    Addressing these factors would help female doctors work more hours and achieve higher equity in pay. Achieving this will require turning away from an attitude of discrimination and toward one of understanding.

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