COMMENTARY

Equal Pay in the Emergency Department

Sumit Patel, MD

Disclosures

May 18, 2016

Let me begin with a story about two young physicians, Zoe and Zach. Both attended 4 years of undergraduate studies at private universities in the United States, which cost $150,000 in student loans. Both went on to attend medical schools in prominent medical institutions in the Northeast, which cost them another $250,000 in student loans. Both were passionate about emergency medicine and applied for—and successfully matched—into highly competitive residencies at their top-choice medical centers. Zoe and Zach both completed 3 years of residency training, receiving the same salary each year and working the same hours because these were dictated by government reimbursement. After graduating, Zoe and Zach began positions as attending physicians at comparable hospitals in cities of the same size. Something strange happens when they start to get their paychecks. Zoe earns less income than Zach. Here's the part that doesn't make sense: They're both working full time.

A Big Difference

Medscape publishes a compensation report[1] annually for physicians and most specialties, based on surveys of each field. The report states: "This year, as in all previous years of the report, male EM physicians are earning more than their female counterparts. Male EM physicians made $332,000 and their female peers $279,000—a difference of $53,000. When asked about this disparity, Travis Singleton of Merritt Hawkins said, 'The persistence of these disparities is puzzling because we see no contractual bias from our clients against female candidates.'" He observed that disparities may exist in work schedules, "particularly with younger female physicians who are in their peak child-rearing years and require more flexible schedules, including part-time.' It should be noted, however, that the compensation reported here is based on full-time positions."

Figure. Medscape EM Physician Compensation Report 2016. Who Earns More: Male or Female EM Physicians?

To me, the most disconcerting fact is that these data are based on physicians who work full-time, which is important, because a strong objection that some individuals have to data like this is that with increasing numbers of female physicians in the field, more of them are switching to part-time work or leaving the workplace entirely to raise children. The Medscape 2016 Compensation Report shows that even in full-time positions, women are still earning less than male counterparts. The reasons for this are not clear. It may be that female EM physicians are penalized for the simple fact that they may eventually require more flexible hours to devote time to childbearing and childcare. This begs many questions. Is it fair for women to be "taxed" for simply being women and the societal expectations that they will be the primary caregiver to any children they have? This discrepancy is an important one to address because it has the potential to affect female EM physicians' earning ability, in addition to many other implications and consequences for their professional careers and family lives.

Making Compensation Fairer for Everyone

I have many concerns as a male working in a field where my female colleagues work as hard as I do, who complete the same training and exams, and literally do the same tasks, yet are somehow paid less than me. Physicians are educated, success-oriented, and mostly hard-working people. We as a group are often viewed as leaders, and as those tasked with helping our fellow citizens along their journeys toward better health, are viewed as role models. What example do we set as emergency physicians, and physicians in general, if we all allow these disparities to continue?

Instead of penalizing female colleagues who want more flexibility at work or equal pay for their work, we should all be actively working to find solutions to the issues that affect women, including female EM physicians. Rather than complain that female colleagues require more flexibility, the conversation should focus on ways that we can all—men and women together—advocate for equal pay and fairer workplace practices.

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