White men still dominate highest-paid clinical specialties

Despite ongoing efforts to diversify the medical workforce, the highest-paidspecialties are still largely white and male.

That conclusion emerges from a recent study of workforce diversity diversity and compensation in medicine published in JAMA. The authors analyzed compensation data for about 773,000 medical trainees in 21 clinical specialties from 2015 to 2022. The trainees self-reported their race and ethnicity as Asian, white, other, unknown, or underrepresented in medicine (URiM), defined as African-American, Alaska Native, American Indian, Hispanic, Latino, Native Hawaiian or Other Pacific Islander. Gender was self-reported as woman, man, or nonbinary.

The authors used academic salaries as a proxy for compensation generally, noting that while most trainees don’t go into academic medicine, many use academic physiciansas proximal role models. Compensation data came from the Association of American Medical Colleges Faculty Salary reports.

The results showed substantial overrepresentation of white male trainees in the surgical specialties—which also had the best-paid academic positions. For example, neurosurgery had the highest faculty salaries among all the specialties studied, ranging from $641,300 for an assistant professor to about $832,000 for a full professor. Among trainees in the field, men comprised 81.4% compared to 17.6% women. Just over half (50.8%) identified as white, compared to 15.5% Asian and 8.5% URiM.

By contrast, in the lowest-paid surgical specialty—obstetrics and gynecology—women were 82% of trainees, whites were 53%, Asians were 10.4% and URiM were 14.7%.Salaries ranged from $304,440 for an assistant professor to $384,680 for a full professor.

Among all surgical specialties, 61% of trainees identified as men and 36.9% as women; 55% as white, 15% as Asian and 8.5% as URiM. Faculty salaries ranged from about $404,000 for an assistant professor to $552,455 for full professors.

Among the nonsurgical specialties, family medicine had the lowest salary range, $237,180 to $271,400. Women comprised 53.5% of the field’s trainees, while men were 45.5%. Just under half identified as white, compared to 18.5% Asian and 14.4% URiM.

The authors say their results suggest that the higher-compensated specialties have been less successful at recruiting women and URiM trainees. They add that possible explanations for these groups’ underrepresentation, such as discrimination, attrition, and specialty culture, require further investigation.

The study, “US Postgraduate Trainee Racial, Ethnic, and Gender Representation and Faculty Compensation by Specialty” was published online August 3 as a Research Letter.