January 30, 2020

Female physicians on average are paid $37,000 less than male physicians in their first job after finishing their residencies or fellowships—and the gap cannot be fully explained by seemingly obvious causes, such as practice area and a desire to have greater control over work-life balance, according to a study published last week in Health Affairs.

Feb. 11 webinar: How to address the leadership gender gap in health care

Study details

For the study, researchers examined the unconditional mean starting compensation of more than 16,000 individuals who finished their residency training or fellowships from 1999 through 2017. The researchers reviewed data from the University at Albany, State University of New York's Center for Health Workforce Studies' New York Survey of Residents Completing Training.

The researchers in the study wrote that they focused on "information about new physicians accepting their first non-training position" because it "minimizes unobserved differences in productivity and work experience that may confound analyses of a wider range of physician seniority."

The researchers noted that the study had limitations, including the fact that the data came from only one state.

Findings

The researchers found women's unconditional mean starting compensation was $198,426 from 1999 to 2017, while men's was $235,044.

According to the researchers, the women and men included the study had many similar characteristics, including sociodemographic and practice characteristics, but there were important distinctions between the women and men. For instance, the researchers found women chose surgical specialties less often than men.

In addition, women were less likely to report spending 50 hours or more per week in direct patient care than men and were more likely than men to rate work-life balance preferences as very important.

The researchers wrote, "Approximately 60% of the unadjusted gap in starting salary could be explained by observable characteristics—primarily specialty and hours spent in patient care." The researchers found that specialty choice had the biggest effect, explaining 40% to 55% of the differences in compensations—with a mean share of 46% during the entire study period.

However, the researchers found that other factors, such as number of job offers and work-life balance preferences, "had virtually no effect on the starting salary differential between men and women."

The researchers concluded, "While it is apparent that women say they place a greater premium on control over work-life balance factors, this difference does not appear to explain the observed starting salary difference, conditional on other factors. There may nevertheless exist workplace biases, whether intentional or unintentional, that differentially affect women irrespective of their individual stated preferences for work-life balance."

Findings confirm prior research, expert says

Reshma Jagsi, director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan, said the findings "provide important confirmation of an uncomfortable truth: men and women, even highly educated ones like physicians, are paid differently for equal work."

Jagsi said her own research has showed "about half of the gender difference in pay of a different sample of physicians was attributable to specialty, just as in this study." Jagsi said her research also "included many other factors that are often proposed as likely causes (including work hours and many other measures of productivity and family characteristics), but it remained impossible to explain away the whole difference—a very similar proportion of the difference remained unexplained in our study."

Jagsi added, "Unfortunately, we have work to do to ensure equal pay for equal work, even after the many strides we have made together in advancing women's participation in the workforce. Systems-level changes to increase transparency and promote consistency in defining the criteria for advancement and compensation are essential in medicine and beyond" (Finnegan, FierceHealthcare, 1/23; Friedman, MedPage Today, 1/27; Lo Sasso et al., Health Affairs, 1/22 [subscription required]).

How to address the leadership gender gap in health care

Women represent over half of medical students and one-third of the physician workforce—but less than 3% of chief medical officers.

Join this webinar on Tuesday, Feb. 11 at 1 p.m. ET to learn how to retain and grow your organization’s next generation of women physician leaders.

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