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References

  1. Sex, Race, and Ethnic Diversity of US Health Occupations (2010-2012). U.S. National Center for Health Workforce Analysis. Administration Bureau of Health Workforce, Health Resources and Services, Department of Health and Human Services. January 2015. http://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/diversityushealthoccupations.pdf Accessed May 5, 2016.
  2. US Department of Health and Human Services. The Physicians Workforce. December 2008 http://bhpr.hrsa.gov/healthworkforce/reports/physwfissues.pdf Accessed May 5, 2016.
  3. Weaver AC, Wetterneck TB, Whelan CT, Hinami K. A matter of priorities? Exploring the persistent gender pay gap in hospital medicine. J Hosp Med. 2015;10:486-490.
  4. Wiley. Why female physicians are paid less than men. ScienceDaily. July 30, 2015. https://www.sciencedaily.com/releases/2015/07/150730120853.htm Accessed May 5, 2016.
  5. Petterson SM, Phillips RL Jr, Bazemore AW, Koinis GT. Unequal distribution of the U.S. primary care workforce. Am Fam Physician. 2013; 87. http://www.aafp.org/afp/2013/0601/od1.html Accessed May 4, 2016.
  6. Finnegan SC, Cheng N, Bazemore AW, Rankin JL, Petterson SM. The changing landscape of primary care HPSAs and the influence on practice location. Am Fam Physician. 2014;89. http://www.aafp.org/afp/2014/0501/od1.html Accessed May 7, 2016.
  7. Casserly M. The geography of the gender pay gap: Women's earnings by state. Forbes. September 19, 2013. http://www.forbes.com/sites/meghancasserly/2013/09/19/the-geography-of-the-gender-pay-gap-womens-earnings-by-state/#645bf26c75d3 Accessed May 5, 2016.
  8. McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K. The work lives of women physicians results from the physician work life study. The SGIM Career Satisfaction Study Group. J Gen Intern Med. 2000;15:372-380.
  9. Darves B. Understanding the physician employment "movement". NEJM Career Center. July 23, 2014. http://www.nejmcareercenter.org/article/understanding-the-physician-employment-movement-/ Accessed May 6, 2016.
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  12. Hayes A. The debt gender gap: how women can close it. US News and World Report. June 26, 2015. http://money.usnews.com/money/blogs/my-money/2015/06/26/the-debt-gender-gap-how-women-can-close-it Accessed May 5, 2016.
  13. Glied S, Ma S. How will the Affordable Care Act affect the use of health care services. The Commonwealth Fund. February 2015. http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2015/feb/1804_glied_how_will_aca_affect_use_hlt_care_svcs_ib_v2.pdf Accessed May 5, 2016.
  14. Boccuti C, Fields C, Casillas G, Hamel L. Primary care physicians accepting Medicare: A snapshot. The Henry J. Kaiser Family Foundation. October 30, 2015. http://kff.org/medicare/issue-brief/primary-care-physicians-accepting-medicare-a-snapshot/ Accessed May 5, 2016.
  15. Centers for Medicare & Medicaid Services. Health Insurance Marketplace Open Enrollment Snapshot - Week 13. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html Accessed May 4, 2016.
  16. Leonard K. Doctors, hospitals say "no" to Obamacare plans. US News and World Report. November 4, 2015. http://www.usnews.com/news/articles/2015/11/04/doctors-hospitals-wont-accept-obamacare-marketplace-plans Accessed May 5, 2016.
  17. Page L. 8 ways that the ACA is affecting doctors' incomes. Medscape Business of Medicine. August 15, 2013. http://www.medscape.com/viewarticle/809357 Accessed May 5, 2016.
  18. The ACA's Sustained Impact on Payer Mix at Medical Practices. Robert Wood Johnson Foundation. September 2015. http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2015/rwjf423784 Accessed May 6, 2016.
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  21. Reese SM. Women MDs spend more time with patients: Does it matter? Medscape Business of Medicine. June 23, 2011. http://www.medscape.com/viewarticle/744653 Accessed May 6, 2016.
  22. Peckham C. Bias and burnout: evil twins. Medscape. January 12, 2016. http://www.medscape.com/viewarticle/856814_2 Accessed May 5, 2016.
  23. Ubel PA, Abernethy AP, Zafar SY. Full disclosure—out-of-pocket costs as side effects. N Engl J Med. 2013;369:1484-1486. http://www.nejm.org/doi/full/10.1056/NEJMp1306826 Accessed May 6, 2016.
  24. Ubel PA, Zhang CJ, Hesson A, et al. Study of physician and patient communication identifies missed opportunities to help reduce patients' out-of-pocket spending. Health Aff (Millwood). 2016;35:654-661.
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Carol Peckham
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Art Science Code LLC
New York, New York

Disclosure: Carol Peckham has disclosed no relevant financial relationships.

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Medscape Female Physician Compensation Report 2016

Carol Peckham  |  May 25, 2016

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Slide 1

According to government data, the percentage of male physicians (65%) still considerably exceeds that of females (35%), although women are catching up and are even surpassing men at younger ages.[1,2] Over 4500 female physicians responded to this year's Medscape compensation survey and disclosed not only their compensation but also how many hours they work per week, how many minutes they spend with each patient, the most rewarding part of their job, changes to their practice resulting from healthcare reform, and more. (Note: Values in charts have been rounded and may not match the sums described in the captions.)

Slide 2

In our 2016 compensation report, men still earn more than women, whether they are primary care physicians (PCPs) ($225,000 vs $192,000, respectively) or specialists ($324,000 vs $242,000, respectively). In the 2012 compensation report, male specialists reported making $242,000 compared with female specialists' $173,000, although a major factor is the small percentage of female physicians in the highest-paying specialties. Male PCPs earned $174,000 and their female peers $141,000. On an encouraging note, women's earnings increased more between our 2012 and 2016 reports than did men's: 36% for female PCPs and 29% for their male peers. Among specialists, the increases are 40% for women and 34% for men. A 2015 study on hospitalist income found similar gender income disparities and suggested that they are partly due to female physicians' "tendency to prioritize collegiality and control over personal time, rather than substantial pay."[3] However, the lead author of the study said, "In addition to implicit bias and differences in negotiations and social networks, women's tendency to prioritize substantial pay less than men may account for some of the gender pay inequities that exist in our society."[4]

Slide 3

Within specialties that include substantial numbers of women, the highest compensation levels were reported by female radiologists ($342,000), cardiologists ($339,000), and dermatologists ($335,000). The lowest were found in female pediatricians ($182,000), family physicians ($183,000), and endocrinologists ($189,000). All of these figures are lower than the overall averages for these specialties.

Slide 4

Physicians responding to this year's compensation survey estimated their net worth using their assets (such as bank and retirement accounts, investments, home equity, and valuable personal property) minus their liabilities (including mortgages, home equity and student loans, and credit card debt). As with earnings, female physicians reported lower average net worth than did their male peers. Nearly half (49%) of men reported net worth of $1 million or more, compared with one third of women.

Slide 5

This year, female physicians who live in the North Central and Northwest regions made the most ($246,000 and $242,000, respectively), while the lowest earnings among women were reported in the Mid-Atlantic ($217,000) and Northeast ($221,000). Geographic supply and demand continue to play a role in compensation. Uneven distribution of physicians relative to patient volume, particularly in primary care, has been a problem for decades in rural and poor communities.[5] Numerous government policies are aimed at improving access to physicians in these areas. As a result, higher incomes are found there.[6] In addition to income levels, however, geography affects the gender pay disparity. In an analysis of the general population,[7] the gender pay gap is narrower in many states in the Northeast, West, and Southwest, while it is widest in the middle of the country. Whether this also applies to physicians is not known.

Slide 6

When looking at physician compensation by age, female respondents' income levels peak in mid-life, at around $250,000 between ages 45 and 54, and then decrease. It should be noted that compensation in this chart is for full-time physicians only and does not include those who work part-time (less than 40 hours per week).

Slide 7

A 2000 study found that income differences between men and women persisted even among younger physicians.[8] In the current Medscape survey, the disparity is lowest in the youngest group (ages 28-34) at 16%, which may suggest that the upcoming generation of female physicians is achieving more equity in income. After age 35, the disparity is consistently around 25%.

Slide 8

In this year's Medscape report, 78% of women in primary care and 74% of female specialists are employed. Reasons for these high percentages include reluctance to deal with the business side of medicine and the desire for a predictable work schedule.[9]

Slide 9

Employed physicians say they're glad they don't have the business responsibilities of self-employed physicians. Although one potential drawback to employment is lower income, the difference in average earnings among female physicians is only $16,000, with those who are self-employed making $189,000 vs $173,000 among their employed peers.

Slide 10

A 2013 national study reported that among Americans overall, men carry 4.3% more debt than do women, mostly from larger mortgages.[10] The differences in debt and expenses between male and female physicians who responded to the Medscape survey, however, were no more than 1%-3% for the top three sources of debt: mortgages, car loans, and paying off school loans. Over two thirds of women (68%) carry home mortgages, 38% car loans, and a third hold student loan debts.

Slide 11

Female emergency medicine physicians and general surgeons were most likely to report ongoing student loan debt (47% and 46%, respectively). Least likely were female infectious disease physicians and cardiologists (both at 21%) and internal medicine physicians and oncologists (both at 24%). These percentages do not appear to reflect relative compensation levels. According to the Association of American Medical Colleges, the median level of medical school debt for men and women in the class of 2015 was $183,000. For physicians who pay over the long term with interest, medical school debt can exceed $400,000.[11]

Slide 12

A 2015 survey found that among the general public, about two thirds of women carry credit card debt compared with one third of men.[12] Medscape's current report, however, suggests that spending habits among female physicians are much more conservative. In this year's Medscape Physician Debt and Net Worth Report, the amount that men and women spend relative to their income does not differ by more than 2% in any category. Seventy percent of female physicians report either living within their means or below them (11% and 59%, respectively).

Slide 13

Among the specialties shown in the chart, the female physicians most likely to believe that they are fairly compensated are pathologists (65%), radiologists (64%), and dermatologists (59%). Radiologists and dermatologists were also in the top three for compensation. Of interest, however, female cardiologist respondents, at 38%, were least likely to report feeling that their compensation is fair, although they were the second highest paid among female physicians.

Slide 14

This year, as in all previous Medscape Physician Compensation Reports, both self-employed and employed male physicians earned more ($341,000 and $277,000, respectively) than their female counterparts ($261,000 and $217,000, respectively). Nevertheless, neither gender expresses great satisfaction with their compensation. Just over half (53%) of male and less than half (48%) of female physicians believe that they are fairly paid.

Slide 15

Among female respondents, 59% of family physicians and 51% of internists reported an influx of new patients due to the ACA compared with 49% among all PCPs. Fifty-seven percent of female emergency medicine physicians had experienced an influx. Although it is still not clear how higher patient volume will affect medical practice, current evidence suggests that it may not lead to worse care.[13]

Slide 16

Eighty-one percent of female physicians say they will continue to take new and current Medicare and Medicaid patients. Only 7% plan to stop taking new ones, and almost none (1%) will stop seeing current patients on these plans. A recent study about primary care physicians accepting Medicare found that although younger PCPs of both genders were more likely to accept new Medicare patients, there was otherwise little difference between men and women.[14]

Slide 17

When asked whether they would drop insurers who pay poorly, 15% of female physicians said they would and just over a third (36%) said they would not. About half (49%) chose "not applicable," probably due to the high number of employed female physicians who do not make decisions regarding insurers.

Slide 18

As of February 2016, 12.7 million Americans (about 4% of the US population) had selected plans through the Health Insurance Marketplace.[15] Current data are limited on the number of physicians who are participating. Often it is employers who make this decision, and many physicians may be locked out of networks.[16] Among female respondents to the 2016 Medscape Physician Compensation survey, the highest rate of participation in the exchanges was reported by gastroenterologists and endocrinologists (both at 28%). The lowest rate (12%) occurred among neurologists, oncologists, and pathologists.

Slide 19

It is not yet clear how the ACA affects physician income. Many variables will ultimately play a role.[17] One study from the Robert Wood Johnson Foundation reported a 3% increase in reimbursement in states that expanded Medicaid eligibility and an increase of 3.3% in nonexpansion states.[18] When female physicians who participated in health insurance exchanges last year were asked whether their income was affected, 67% reported no change and 9% said it had increased. About a quarter (24%) experienced a decrease. Nevertheless, according to a 2013 survey, women are more optimistic than men in their belief that health insurance reform will improve patient care.[19]

Slide 20

Forty percent of male physicians spend 46 hours or more per week with patients compared with slightly over a quarter (26%) of their female peers. Men's longer hours may help explain the compensation disparity between the genders. A 2013 Canadian study reported that among women, but not men, the effects of marriage—and, even more pronounced, raising children—resulted in fewer work hours. There was no difference in hours worked between male and female physicians who were not married and did not have children.[20] It should also be noted that in a 2000 study, longer hours were associated with burnout in female physicians. In the study, women were 1.6 times more likely to experience burnout than men, with the women's risk increasing by 12%-15% for every 5 hours worked per week over 40 hours.[8]

Slide 21

The amount of time that physicians spend with patients is often an issue, and lately both physicians and patients complain about getting even less time. However, this year's results were consistent with those of all of our surveys since 2011: 13-16 minutes is the most common amount of time spent with patients, followed by 17-20 minutes. Previous Medscape research found that female physicians spend more time with patients on average.[21] Indeed, in the 2012 Medscape Physician Compensation Report, 55% of female physicians reported spending 17 or more minutes with their patients compared with 48% of men. This is influenced by the nature of the specialties that women tend to choose or avoid; there are very few female physicians in critical and emergency care, which involve shorter physician visits. In this year's report, however, the difference diminished, with 48% of women and 41% of men spending 17 or more minutes with patients.

Slide 22

Bureaucratic tasks were the prime cause of burnout among all physicians, according to this year's Medscape Lifestyle Report (and in previous ones as well). Medscape's Compensation Reports through the years suggest that the paperwork problem is only getting worse. In the 2014 report, 35% of all employed and 26% of all self-employed physicians spent at least 10 hours per week on paperwork. This year, 59% of female physicians spent this much time on paperwork. It should be further noted that according to Medscape surveys, burnout rates in women are higher than those in men and are getting worse.[22]

Slide 23

The authors of a 2013 editorial in the New England Journal of Medicine wrote, "Because treatments can be 'financially toxic,' physicians need to disclose the financial consequences of treatment alternatives just as they inform patients about treatments' side effects."[23] Authors of a recent qualitative study on this subject wrote, "For consumer health care markets to work as intended, physicians need to be prepared to help patients navigate out-of-pocket expenses when financial concerns arise during clinical encounters."[24] This year, 85% of female physicians for whom this issue was applicable say they regularly or occasionally discuss the cost of treatment with patients, which is about average for all physicians.

Slide 24

Despite complaints about red tape, work requirements, and changes in the healthcare field, a full 98% of female respondents found gratification in being a physician and treating patients. This year, the highest percentages cited relationships with patients (37%) and being good at their job (30%). The least selected factors were pride in being a doctor (6%) and making good money at a job they like (10%).

Slide 25

While the rewards of medicine still exist for the majority of all physician respondents, there has been a steady decline in the number who would choose to be a doctor again. The Medscape Physician Compensation Report survey has included this question for the past 5 years, and enthusiasm has waned with each successive year. In the 2011 report, 69% of physicians said they would choose medicine again and 61% would select their own specialty. This year, 64% of all physicians would still choose medicine, but only 45% would select their own specialty. Women responded even more negatively this year, with only 58% saying they would choose medicine and 38% their own specialty. In a major study published in JAMA, women tended to be more satisfied than men with their specialty and patient and collegial relationships, but they were less satisfied with their level of autonomy, community relationships, pay, and resources.[25]

Slide 26

Among women, more neurologists (73%) than any other specialists would choose medicine again. Still, money is not the major factor in this choice; 71% of female family physicians and 70% of their internist peers would choose medicine again despite their lower pay (in the bottom 10) among specialists. The female specialists least likely to choose medicine again were ophthalmologists (46%), general surgeons (47%), and dermatologists (49%). The latter two were within the top 10 in earnings among respondents, again suggesting that earnings are not a major factor when female physicians reflect on their choice to pursue medicine.

Slide 27

Although only about half (49%) of female dermatologists said they would choose medicine again, more than two thirds (68%) said that if they did, they would choose their specialty again. In second place, at 64%, were gastroenterologists. At the bottom of the list, only 23% of female internists and 28% of female family physicians would want to be primary care doctors again, but both groups were in the top three among specialists who would again choose a career in medicine.

Slide 28

To determine general career satisfaction among female physicians, Medscape averaged the percentages of those who would choose a career in medicine again, those who would choose their specialty again, and those who believed that they were fairly compensated. This year, at 59%, female radiologists were the most satisfied, followed by dermatologists (58%) and pathologists (56%). The least satisfied were general surgeons and internists (both at 45%) and ophthalmologists (46%). These low ratings appear to have less to do with the specialists' earnings than with their career satisfaction. Pathologists, radiologists, and dermatologists were the top three, respectively, among those women who felt fairly compensated, while surgeons, internists, and ophthalmologists were in the bottom six.

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