6 ways to close the gender pay gap in medicine

Here are the sad the financial facts. You have heard them before:

  • Women physicians earn $0.62 on the dollar as compared to men (US Census Bureau, 2010).
  • Women physicians start out their careers with a $17,000 pay gap, after all other factors are accounted for (LoSasso, Health Affairs 2011).
  • Mid-career women physician researchers are paid $12,000 than their male counterparts (Jagsi, JAMA 2012).

Anyone who discounts that fact that we women physicians are discounted in the area of pay equity should get educated.  With that being said, “What’s a woman to do?”

Here are 6 ways women physicians can close the gender pay gap.

1. Negotiate, negotiate, negotiate.  Start out with the knowledge that whatever you are offered, it  is probably 40% less than you would be offered if you were a man.  Look at the first offer as only a first offer–expect to negotiate.  And having a good negotiating strategy– before you start–is critical to getting your “number.”

2. Do your homework.  Know what you are worth.  This means you have to access data from multiple sources:   other physicians are the best source, so don’t be shy about asking.  It’s time we talked to each other.  A few other sources to get you started:  Academic salaries are reported by the American Association of Medical Colleges.  The information is pricey and their self-reporting mechanism under-estimates worth due to the variations and complexities of the various faculty practice plans and how faculty salary is determined.  The Medical Group Management Association (MGMA), has information about other group practice arrangements, again for a fee.  And Physician’s Practice can clue you in on your own worth as a physician in your own practice–membership required.

3. Leverage the doctor shortage.  Your services are going to be more valuable if there are fewer people who can provide them. Right now there are more than 6000 physicians jobs listed on one website.  Be prepared to walk away from a place that undervalues you.  And make sure you tell them why.  Nicely.

4. Know the market. Know that the highest (orthopedics, cardiology and radiology) and lowest paying specialties (general internal medicine, pediatrics and family medicine).  Whether or not you agree with how it is, that is how it is.  If compensation is important in your career decision tree, know the facts.  (By the way, this speaks to horizontal segregation where women are openly encouraged in medical school to populate these lower paying specialties, thus further keeping the compensation rates down.)  Choose your career on your interests, but be mindful of the value placed before you go in.

5. Know your geography.  If you have flexibility, think about going to places that really need doctors.  Central US needs you badly.  The northeast, not so much.  This is going to vary by specialty.

6. Don’t overestimate the worth of flexibility, predictability and control.  The most commonly given reason that women physicians are paid less is that they “give away” salary compensation for flexibility, predictability and control of their lives.   And maybe we do, but we don’t have to do it disproportionally to their worth.  No big secret, men want the same things and don’t give away their money to get them.  All three can be sold as “assets” rather then “deficits.”  Don’t trade away more than you need to.

A lot of this is mindset but a lot is careful planning.  So, start off on the right foot.  Do your homework.  Create your prioritized “shopping list.”  Make sure you marshal all of your untapped assets.  And get the right help.  You will be much more respected as a physician if you are smart about you as your greatest asset.

Linda Brodsky is a pediatric surgeon who blogs at The Brodsky Blog.  She is founder of Women MD Resources.

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  • bladedoc

    Neither CMS or any insurance company has any idea if you are male or female when you submit a bill. Most non-academic contracts are production based in my experience. How does this make sense with your thesis above?

    • LBENT

      This is always brought up as a reason for disparities. there is a long answer, but here is the short answer: Many insurance companies negotiate different contracts with different providers–men negotiate better, women take the fees at face value. Also women are more likely to “take jobs” in practices and are not paid what they are billing for that practice. So this is not an exact analogy, as you can see. Linda Brodsky

      • ninguem

        Many insurance companies negotiate different contracts with different providers……

        heh, got that right. You might have read about the pissin’ match with the Proliance surgeons and Blue Shield a couple years ago. It made the Puget Sound Business Journal, usually paying attention to the big fish like Boeing and Microsoft and Starbucks and Costco. The dollar figures involved was enough to get their attention, which impressed me.

        Negotiation at my level…..being of the male persuasion…..goes through IPA’s and the medical association, all gender-neutral. Mostly my negotiation consists of walking away from really bad payors.

        You can do a little bit more negotiation as a pediatric surgeon, you’ve earned it.

        “…….Also women are more likely to “take jobs” in practices and are not paid what they are billing for that practice……”

        You’re doing it again, comparing apples and oranges. I’m 100% solo, but that woman coming to “take a job” at my practice, gets paid before I do. The reality of business ownership.

        • ninguem

          And for what it’s worth, if you ask me, since you want to make things better for women physicians, who tend to “hold a job” and all that (I agree)……

          Number One thing to do, that should be done through your medical association and specialty associations.

          Resolve, that restrictive covenants or “noncompetes” in medical employment contracts, are considered unethical practice, with recommendation that the Legislature pass laws to that effect.

          Biological reality is going to be “mommy track” for a fair number of women. They are also more likely to be locked into a geographical location because of a husband’s job.

          Employers can lock women into a job and make it hard to find a better deal if they can’t leave town. Give a female physician the same job flexibility as a nurse.

          And, considering that every Bar Association in the country considers restrictive covenants unethical when hiring LAWYERS, it would also be nice if the medical associations RAISED their ethical standards up to the level of lawyers.

          • LBENT

            Good point about the restrictive covenants.
            Bad comparison to nurses. Doctors carry around responsibility 24/7/365.

          • ninguem

            Oh I agree, just saying the nurses have the freedom to go down the street and work for the hospital’s competitor if desired.

            Are you at Buffalo Children’s? Nice place. I was looking to go there for training, I chose Cleveland Clinic instead, and I wonder if I made the right choice.

          • LBENT

            yes, I am. and you did make the right choice. the hospital has been dismantled of a “medical center” status. sad.

          • ninguem

            Oh, I didn’t know that. This was some time ago, I didn’t know what had happened in the interim.

            After interviewing, I treated myself to a concert, a place called the Tralfamadore I think, is it still there? I saw BB King. He gave me a guitar pick after the concert, he used to hand those out as souvenirs after concerts.

            I enjoyed the town, the couple days I spent there, but that was some time ago.

  • Anon

    How about closing the pay gap by working more to bring your hours closer to men’s hours?
    A significant percentage of women docs work part time. It exacerbates the doc shortage and gives new women docs even more leverage to negotiate for fewer hours, part time work, and no call. Vicious cycle.

    • http://www.facebook.com/beau.ellenbecker Beau Ellenbecker

      Agreed. There is a gender pay gap in many professions but in Medicine it is almost strictly to do with hours worked and pro-bono work (coding a 212 instead of a 213 for the family that has money isssues…etc.). Every study I have read shows a significant hours worked gap in Physicians pay with women working around 12-15 less hours a week.

      • LBENT

        You obviously are not familiar with recent literature. See above comment. Also another excellently designed study by Jagsi, in JAMA 2012

        • ninguem

          I found the Jagsi study. It’s online.

          I’m not impressed at all. They’re looking at academic physicians. That’s politics, I’ve been in academics, the games played with finances are staggering. I’ve been in the fights.

          Though at the same time I have to agree with you, there’s likely gender bias in academics, heck gender bias has been alleged in the Obama White House.

          That’s not the only bias we see in the ivory tower.

          It doesn’t tell me much about real-world private practice. Solo and small group practices don’t do much negotiation directly with insurance, I know I don’t. I work through the medical associations, the IPA’s, the statistical analyses that exist. Bust mostly we get hit with “take it or leave it”.

          Sometimes when I have chosen to “leave it”, some insurances have come back to negotiate.

          But back to the paper, in their own sample analysis, they find:

          - Women tended to be in lower-paying specialties

          - Men were more likely to be at a different academic institution than the one at which they received their K
          awards

          - Women were less likely to hold administrative leadership positions

          - and had fewer publications

          - and work hours

          The “different academic institution” thing reflects what is found with the gender pay disparity studies generally. They’re not comparing the same work, and in the case of moving around, men may be seeking opportunity more aggressively.

          The fewer administrative leadership positions, there may well be gender bias there, there’s plenty of games played in the ivory tower.

          I have a brother-in-law who got mentioned in a newspaper “expose” of municipal employees with outrageously high pay. He had a high school degree and a relatively low paying job. But he grabbed every bad shift, holiday, and took flexible locations, time and a half, holiday shift differentials, etc., to bring home pay that was so high it was a statistical outlier and even got in a news article. He saw his opportunities and he took ‘em.

          To provide for his family.

          Maybe women are discounting their time, taking too much of a pay cut for mommy track work. What’s the price of that shift?

          I’ve been around the block long enough to have seen fights…….lots of fights…..big drag-out fights….when docs started asking to be taken off call because of age. A guy in his 50′s that says I’ve been doing this 20 years and it’s time to slow down. The OB/GYN that wants to do just GYN and the OB/GYN’s try to pull the doc’s GYN privileges.

          As bitter as some of those fights were, I would daresay that someone considered that time off-call to be very valuable. Maybe the market set the price properly.

          Maybe not.

    • LBENT

      There is plenty of evidence that even when women work the same hours, and have the same “productivity”, they are paid less. (LoSasso et al, Health Affairs 2011). You can find other similar articles on http://www.womenmdresources.com Linda Brodsky

  • jkyu99

    7. Work for a salary at a center where gender is not part of the payroll calculator program. It won’t mean you take home equal pay if you don’t work equal hours, but it helps to start at a level playing field.

    The difference comes in two major areas.

    1. Medical Specialty chosen (base salary) for full-time work varies among men and women.

    2. Within the same specialty, physicians that chose to work part-time differs by sex and by age. Our younger physicians are choosing to work fewer hours and as a senior physician retires it costs us more than one body to replace him/her to maintain the same productivity hours per week. A long way to say, each person earns less because they chose to work less and among those young people, the women chose to work less hours too.

    It could go a long way to explain a 62% difference in take home pay.

    • LBENT

      Yes. Healthcare workplace productivity is a complex topic.

  • ninguem

    “…..By the way, this speaks to horizontal segregation where women are
    openly encouraged in medical school to populate these lower paying
    specialties, thus further keeping the compensation rates down…..”

    By saying this, the author implies that these pay disparity studies are comparing, for example, full-time male orthopaedic surgeons, with females working part-time as a FP to spend time with small children.

    Then the author goes on
    “…….The most commonly given reason that women physicians are paid less is that they “give away” salary compensation for flexibility,
    predictability and control of their lives. And maybe we do, but we
    don’t have to do it disproportionally to their worth…..”

    Which is an admission that these studies are comparing apples and oranges. There really is an economic tradeoff for lifestyle, just a dispute over whether women discount themselves too much for the lifestyle choice.

    • LBENT

      I did not talk about specific studies but about how women earn less for many reasons. You are correct in that we cannot compare surgeons to primary care providers, but even within specialties (see studies noted above) women are less likely to get the same compensation. Yes, you are right, I am saying that women are giving away more than they should and more than they have to for lifestyle. Men, too, are now looking at lifestyle tradeoffs, but are not taking major salary cuts to do so. Linda Brodsky

      • mr. 6&8

        I am a private practice pediatric subspecialist surgeon as well. We have a group and salaries are blind male/female. We get a base salary and then productivity from there. The best thing I ever did was hire a woman (my wife) to negotiate contracts. Doctors have no business negotiating contracts with insurance companies…hire a professional male or female. They know the market, how the contracts work from top to bottom, where most docs only look at fees.
        We have had females in our prctice and they werre treated equally, financially, cases done, patients seen…everywhere.

  • buzzkillerjsmith

    Women are nicer and less selfish than men. That is the way it was, is, and shall be, in this and in every other society. They don’t have the viciousness to earn the money we earn. They actually care about what others think about them. And they don’t have wives and children to support.

    But they live longer.

    • LBENT

      Great take on this Buzz!

      • ninguem

        heh, yeah, I knew a doctor, female, in independent practice, and obvious deadbeat types would hit her up for free services, with that line that you’re a female, she cared more and all that, compared to the male down the street.

        “Caring” in their eyes meant willing to work for free.

        Mrs. Ninguem did her billing and was appalled.