Roberta Gebhard, DO, thought that her 20 years of experience as a physician in the U.S., 10 of them as a hospitalist, would mean she would get paid more than a new graduate just out of residency would.
She was wrong.
Dr. Gebhard was working at a hospital run by the U.S. Department of Veterans Affairs when she learned that the less experienced doctor—a man—was making $10,000 more a year than she was.
“After that, the job was no longer interesting to me,” says Dr. Gebhard, who left the hospital over the pay discrepancy and now works as a hospitalist at WCA Hospital in Jamestown, N.Y. “Women think that things should be fair, so they assume that they are. I’m a good negotiator, and when that happened to me, I was like, ‘Wait a minute! I didn’t just take what they offered me.’ I pushed a few times and was basically told it was a government position, there was no wiggle room, and I couldn’t get more salary.
“It happens, and women need to know that it happens,” she says.
Earnings data and research show that the gender pay gap lingers. More problematic is pinpointing why the gap won’t close. Explanations range from ignorance of the issue and trading in compensation for other job benefits to women’s lack of negotiating skills to subtle gender discrimination.
Because gender pay discrepancies persist and because theories abound as to the cause, the issue will be addressed during a “Women in Hospital Medicine” session at HM12 next month in San Diego, along with such topics as leadership challenges and work-life balance, says Patience Reich, MD, SFHM, a hospitalist and assistant professor of medicine at Wake Forest University School of Medicine in Winston-Salem, N.C.
“When we conceived the session, we were actually thinking about women in leadership, but decided to go for more general topics that affect women hospitalists, whether they are in leadership or not,” says Dr. Reich, a member of SHM’s Leadership Committee who helped coordinate the HM12 session.
According to the 2011 SHM-MGMA compensation and productivity survey, mean annual compensation for female hospitalists in family practice, internal medicine, and pediatrics is lower than that of their male counterparts. For example, female hospitalists in family practice, internal medicine, and pediatrics have mean annual compensations of $219,995, $215,012, and $170,535, respectively, or $4,448, $29,211, and $23,402 less than male counterparts in similar positions (see Figure 1). Such factors as practice location, practice ownership, and productivity have an effect on compensation and could be the reason behind the disparity, says Liz Boten, a spokeswoman for Englewood, Colo.-based Medical Group Management Association (MGMA).
But research that is controlled for numerous observable factors has shown that the gender earnings gap continues to exist among physicians.1,2,3,4 Of particular note are two studies, including one focused on hospital medicine.
In 2004, a study authored by Timothy J. Hoff, PhD, an associate professor at State University of New York at Albany, controlled for a wide range of work and non-work variables, including clinical workload, compensation type, employer type, tenure, marital status, and tenure in hospital medicine.5 The data show that female hospitalists earned approximately $22,000 less per year than male hospitalists, despite similar work patterns. Additional study results showed that married female hospitalists with children worked just as much and carried as heavy a clinical workload as married male hospitalists who had children.
—Roberta Gebhard, DO, hospitalist, WCA Hospital, Jamestown, N.Y., American Medical Women’s Association’s Gender Equity Task Force co-chair
Last year, a study in Health Affairs generated considerable interest when it found that male physicians newly trained in New York state made on average $16,819 more than newly trained female physicians in 2008, compared with a $3,600 difference in 1999.6 The authors controlled for specialty type, hours worked, designation of hours, immigration status, age, and practice location. And by focusing on starting salaries, factors such as job tenure, institutional rank, and job productivity didn’t come into play, signifying that the experiences of married female and male hospitalists with children differed less than one might presume based upon perceptions that women with families sacrifice work commitments to take care of their spouses and children.
“It is studies like this that are going to be critically important for us to move forward,” says Janet Nagamine, RN, MD, SFHM, a hospitalist at Kaiser Permanente Medical Center in Santa Clara, Calif., and an SHM board member who is assisting with the “Women in Hospital Medicine” session at HM12. “As we talk about a pay gap, we need to be more evidence-based.”
Studies that show a gender earnings gap even among highly skilled professionals don’t surprise researchers. The U.S. Bureau of Labor Statistics collects earnings data on hundreds of occupations, including physicians, and men outearn women across the board, regardless of educational requirements, says Mary Gatta, PhD, past director of gender and workforce policy at the Center for Women and Work at Rutgers University in New Brunswick, N.J., and current senior research scholar at Wider Opportunities for Women, a Washington, D.C.-based organization that focuses on opportunity equality for women.
The Gap that Won’t Close
So why, in 2012, do gender-based pay discrepancies remain?
How much people earn typically is not public information, so women often don’t know they aren’t being paid equally and, therefore, don’t have information on which to act, Dr. Gatta says.
“My opinion on it is women don’t know about the pay gap,” says Dr. Gebhard, co-chair of the American Medical Women’s Association’s (AMWA) Gender Equity Task Force. She recalls a salary negotiation lecture she helped lead after which a woman finishing residency raised her hand to say she was joining a faculty where everyone was paid the same. “The entire room just groaned,” she says. “Clearly, women out there think everything is fair and people are paid the same. They don’t know they’re being paid less.”
In trying to explain the widening pay gap, authors of the 2011 Health Affairs study posited that the influx of women into the physician workforce is reshaping the practice and business of medicine.6
“The notion we suggest is that the increasing gender gap can be explained by new women physicians increasingly demanding non-pecuniary aspects of their jobs, and because of the greater aggregate presence of women in the physician labor market, being able to get it,” says lead author Anthony Lo Sasso, a professor and senior research scientist at the School of Public Health at the University of Illinois at Chicago. “Remember, cash wages are but one part of the compensation package in any job.”
Hoff’s study also uncovered gender differences in employment preferences, with men attracted to HM for the compensation possibilities and women for the predictable hours and lifestyle flexibility. For this reason, Hoff suggested, hospitalist employers can use different recruiting pitches for women than men and, to the extent they hire female hospitalists, save money (see “Negotiating Strategies for Better Compensation,” below).
“The Hoff paper is a goldmine,” says Linda Brodsky, MD, a pediatric otolaryngologist in Buffalo, N.Y., who co-chairs AMWA’s Gender Equity Task Force and whose organization, Expediting the Inevitable, advocates for gender equity in healthcare. “How is it that when you have shift work, women are getting paid less per shift? Because Hoff tells you at the end, employers can get away with it. Even if they know they are underpaying women, they will take the chance because it’s so hard for anybody to take legal action.”
Women also find themselves in a double bind when it comes to negotiating higher compensation, says Barbara Gault, PhD, executive director of the Institute for Women’s Policy Research in Washington, D.C. Some suggest a pay gap exists because women are not negotiating for themselves, but research shows women tend to be perceived as less likable when they are more assertive about higher wages, she says.
Erin Stucky Fisher, MD, MHM, has seen this phenomena play out in her roles as medical director for quality at Rady Children’s Hospital in San Diego and associate program director for the University of California at San Diego Pediatric Residency Program.
“I do a lot of interviewing for the hospital, and it does seem, in general, that women are less likely to promote themselves than men in the same situation,” says Dr. Fisher, an SHM board member who is also assisting with the HM12 “Women in Hospital Medicine” session. “There are reasons behind it that might have to do with women not wanting to be perceived as self-serving or arrogant.”
—Erin Stucky Fisher, MD, FAAP, MHM, medical director for quality, Rady Children’s Hospital, associate program director, University of California at San Diego Pediatric Residency Program, SHM board member
Dr. Brodsky agrees with the perception issues facing physicians.
“Women are supposed to be grateful, accommodating, and get along, which are excellent qualities,” she says. “But when you’re expected to do that and you instead negotiate with any kind of spirit, it’s perceived as troublemaking, whereas in men, it’s perceived as strength.”
Subtle forms of gender discrimination continue to exist in workplaces, Dr. Gatta says. Beliefs remain that men have a family to support, so they should be paid more, and that women are in the workforce just for extra money, even though recent data show that women’s income is key to families’ well-being, she notes.
Common patterns of gender bias will be discussed at the HM12 session, says Dr. Reich, who was a victim of gender pay disparity when she worked a locum tenens job earlier in her career.
“There was no logical explanation. The men did less work by all measures, and the other woman and I didn’t have young children at home, so explanations of women trading in money for time with family didn’t apply,” she explains. “Why did they think I should be paid less? I didn’t understand, and I never got a logical reason.”
Shortly after arriving at Wake Forest in 2004, Dr. Reich had the opportunity to build the hospitalist program. A set of thorough, transparent criteria for determining compensation were established almost immediately to help prevent pay discrepancies.
“We tried to be as objective as we could, and we involved the group in talking about it because we felt it was important,” she says.
—Linda Brodsky, MD, pediatric otolaryngologist, Buffalo, N.Y., co-chair, AMWA Gender Equity Task Force
Organizations can conduct self-audits to assess whether men and women are being compensated equitably, then make adjustments when necessary, Dr. Gault says. Policies can be adopted to promote pay transparency and allow employees to discuss compensation and suggest ways it can be improved, she adds. In workplaces where compensation discussions are discouraged, women can try to informally speak with their male friends to gather information and determine if there’s a pay gap problem.
Equal pay laws, such as the Lily Ledbetter Fair Pay Act, exist at the federal level. But Dr. Gatta says work must be done on the enforcement end to make a real difference. Similarly, Dr. Brodsky describes the Equal Employment Opportunity Commission as a toothless oversight agency with limited power to investigate complaints and assess fines.
“It’s on women to go and be the whistleblower, the policeman, and pay for legal action. It’s impossible,” she says. “When you utter the words ‘gender discrimination,’ immediately, retaliation goes into high gear.”
While employers and enforcement agencies have a significant role in closing the pay gap, women themselves must collectively advocate for equal pay, Dr. Gault says.
“Any woman physician who is in the senior ranks must be obligated to start changing the culture and making sure the fairness issue gets raised and is an important part of their agenda,” Dr. Brodsky says. “Enough women are now part of the physician population. They have to start saying, ‘We are a group to be reckoned with, and we are going to make changes.’”
Lisa Ryan is a freelance writer based in New Jersey.
- Wright AL, Schwindt LA, Bassford TL, et al. Gender differences in academic advancement: patterns, causes, and potential solutions in one US College of Medicine. Acad Med. 2003;78(5):500-508.
- Ash AS, Carr PL, Goldstein R, et al. Compensation and advancement of women in academic medicine: is there equity? Ann Intern Med. 2004;141(3):205-212.
- Ness RB, Ukoli F, Hunt S, et al. Salary equity among male and female internists in Pennsylvania. Ann Intern Med. 2000;133(2):104-110.
- Weeks WB, Wallace TA, Wallace AE. How do race and sex affect the earnings of primary care physicians? Health Aff (Millwood). 2009;28(2):557-566.
- Hoff TJ. Doing the same and earning less: male and female physicians in a new medical specialty. Inquiry. 2004;41:301-315.
- Lo Sasso AT, Richards MR, Chou C, Gerber SE. The $16,819 pay gap for newly trained physicians: the unexplained trend of men earning more than women. Health Aff (Millwood). 2011;30:193-201.