Female Academic Physicians Make $20,000 Less Than Male Peers

Nicola M. Parry, DVM

July 12, 2016

Female academic physicians at public medical schools in the United States have lower average salaries than their male colleagues, even after adjusting for factors such as age, faculty rank, and publication record that typically affect academic income, according to a new study published online July 11 in JAMA Internal Medicine.

"[W]e found that annual salaries of female academic physicians were 8.0% ($19,879) lower than those of male physicians," Anupam B. Jena, MD, PhD, from Harvard Medical School, Boston, Massachusetts, and colleagues. "This difference represents 38.7% of the unadjusted difference in salary between men and women."

Despite an increasing number of women in medicine in recent decades, gender income gaps continue to persist. Within academic medicine, in particular, studies have shown that female physicians earn less than their male colleagues after adjustment for factors such as age, years of experience, specialty, reported work hours, and faculty rank. However, these studies have been limited by factors such as reliance on survey-based approaches, lack of contemporary data, small sample sizes, and limited geographic representation.

With this in mind, Dr Jena and colleagues conducted a study of gender income differences among academic physicians that was designed to reduce many of these limiting factors. They used Freedom of Information laws to evaluate salary information data for academic physicians at 24 public medical schools in 12 states and combined these data with information on clinical and research productivity.

The study included 10,241 faculty physicians, of whom 3549 (34.7%) were women, a similar proportion to that seen among other US medical schools that were not included in the study.

Women had lower mean unadjusted salaries than men ($206,641 vs $257,957; absolute difference, $51,315; 95% confidence interval [CI], $46,330 - $56,301).

According to the authors, women were less likely than men to be full professors (20.2% vs 38.0%; P < .001), were younger (mean age, 46.4 vs 51.1 years; P < .001), and had completed residency more recently (14.6 vs 19.4 years; P < .001). More women specialized in internal medicine (11.3% vs 7.9%), obstetrics and gynecology (6.8% vs 2.7%), and pediatrics (17.6% vs 9.9%). Women also had fewer total publications (13.5 vs 26.1; P < .001) and were less likely to have research funding from the National Institutes of Health (11.6% vs 16.1%; P < .001) and to have conducted a clinical trial (8.1% vs 11.6%; P < .001). In addition, women were also less likely to have received Medicare reimbursements, and among physicians receiving payments, women received a lower mean amount than men ($38,409 vs $52,320; P < .001).

Nevertheless, even after adjusting for these factors, 38.7% of the unadjusted gender income difference remained ($19,878 adjusted difference; $51,315 unadjusted difference), and women's annual salaries were 8.0% lower than men's salaries ($227,783 [95% CI, $224,117 - $231,448] vs $247,661 [95% CI, $245,065 - $250,258]; absolute difference, $19,878 [95% CI, $15,261 - $24.495]).

Salary differences were greatest for orthopedic surgery, obstetrics/gynecology, other surgical subspecialties, and cardiology; differences were smallest in family medicine and emergency medicine. In contrast, adjusted average salaries were slightly higher for women in radiology than for men. Gender differences in salary also varied across institutions and faculty ranks.

"Our use of publicly available state employee salary data highlights the importance of physician salary transparency to efforts to reduce the male-female earnings gap," the authors conclude.

In an invited commentary, Vineet M. Arora, MD, MAPP, from University of Chicago, Illinois, recalled the words of equal pay advocate Lilly Ledbetter, who spent years fighting the gender income gap: "No one should get paid less for doing the same job because she is a woman."

According to Dr Arora, the income gap in medicine is particularly concerning because, despite equal representation among genders in medical schools' admissions, the gender pay disparity is one of the largest among professionals.

Because women's reduced ability or desire to negotiate for higher salaries may partly underlie the gender income gap, Dr Arora suggests interventions to enhance women's negotiating skills represent one potential solution to help close the gap.

In addition to increasing transparency in salaries between men and women, she says institutions must also improve efforts to promote women into senior leadership positions.

"Fixing the pay gap between male and female physicians in academic medicine requires more than just studies showing that it exists; concerted efforts are needed to understand and eliminate the gap. Fixing the gap will also require the courage and leadership of women academic physicians—the 'Dr Lilly Ledbetters' out there—to advocate to eliminate it. It is time that the 'woman card' be worth the same amount as the 'man card,' " Dr Arora concludes.

Dr Jena received funding for this study from the National Institutes of Health. The other authors have disclosed no relevant financial relationships. Dr Arora is a member of the board of directors of the American Board of Internal Medicine and is a founding member of Women of Impact for Healthcare, a 501c3 organization.

JAMA Intern Med. Published online July 11, 2016. Article abstract, Commentary extract

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