In Texas, a primary care physician working in a Denton County clinic discovered she was being paid $34,000 less per year than a male physician who performed the same duties. She questioned the matter and was later fired by administrators, who cited poor job performance.
The Equal Employment Opportunity Commission (EEOC) brought the doctor’s claim to federal court. In a resolution reached late in 2018, a judge ordered the county to pay the female doctor $115,000 in damages and to correct its compensation policies.
In spite of numerous equal-pay regulations and ongoing EEOC enforcement, female physicians are chronically underpaid compared to their male counterparts.
“For every specialty and every geography, there is a significant gap,” says Christopher Whaley, Ph.D., an adjunct assistant professor at the University of California, Berkeley School of Public Health, who has studied the gender pay gap.
Medical Economics found in its survey of primary care physicians that female physicians reported a median annual income of $175,000, while male physicians reported an income of $275,000. In other words, the women surveyed earn 63 cents for every $1 that men earn. At the highest end of the pay scale, 10 percent of male respondents say they earn $500,000 or more compared with only 3 percent of female respondents.
These results are similar to other industry studies, including one conducted in 2017 by Doximity, a social network of medical professionals. In its study of more than 65,000 physicians, the organization discovered that industrywide, women earned 27.7 percent less than men. When examined by specialty, data provided to Medical Economics show women family medicine doctors earn $212,535 annually, or about 83 cents per $1 that their male counterparts earn.
Based on the dollar figures reported in the surveys, it’s clear the lost lifetime earnings for a female physician can add up to $1 million or more. Whaley, who was the lead author on the Doximity study, says it’s surprising that medicine—with its intensive education requirements and high standards applied uniformly to all professionals—would demonstrate such wide discrepancies in compensation between men and women.
“It’s not as if a woman in the study sample had inadequate training,” he says.
Reasons behind the gap
The Equal Pay Act of 1963 was the first law making it illegal for employers to pay women less than men for doing the same job. Subsequent state and federal rules have aimed to reinforce pay equality, but the regulatory stick hasn’t been enough to level out earnings. Census Bureau data from 2016 show America’s working women are earning just 80 cents for every $1 that men earn.
Implicit bias is often to blame for the historic pattern of discrimination, experts say. For example, women are less likely to be perceived as family breadwinners or as loyal workers willing to put in long hours, says Theresa Rohr-Kirchgraber, MD, FACP, executive director of the Indiana University National Center of Excellence in Women’s Health and a chief physician executive at Eskenazi Health. Rohr-Kirchgraber has studied gender pay gaps for years.
She advises female physicians—many of whom are in fact the breadwinners in their households—to avoid talking about personal issues at work. If a woman declines a meeting invitation because of childcare concerns, for example, it’s in her own best interest to skip the explanation. Talking about outside demands can give the impression that professional duties aren’t a priority.
“It set us up to look as if we’re not as enthusiastic about our jobs,” Rohr-Kirchgraber says.
Yet she doesn’t believe men in medicine are deliberately acting with a gender bias, or worse, encouraging it to gain their own financial advantage. “There is plenty of work to go around,” she says. “Guys are just as confused as women as to why this is happening.”
Lack of transparency
Another reason for pay gap's persistence is that organizations often keep workers’ salaries and bonuses confidential. Without that data, women can’t quantify discrimination, making it extremely difficult to address.
Sharona Hoffman, JD, LLM, professor of law and bioethics at Case Western Reserve University School of Law in Cleveland, says women in medicine need to start asking questions and advocating for transparency. “It might seem impolite, but if women are serious about closing the pay gap, they need the data,” Hoffman says.
Ana María López, MD, FACP, president of the American College of Physicians (ACP), says even if an organization won’t reveal comparative compensation data, physicians have a responsibility to do their own research. Other factors determine pay, such as regional market differences, years of experience, or hours of clinical time in proportion to other professional duties. Such data can build a case for negotiating higher pay.
“At my first job as an assistant professor, I remember being told my starting salary,” López says. “I just said 'thank you,' and I had no idea that I could have done research and negotiated anything.”