Female Physicians Paid $19,000 Less Per Year Than Male Peers

Nicola M. Parry, DVM

August 19, 2016

Medicare reimburses female physicians in the United States significantly less than their male colleagues, even after adjusting for factors such as hours worked, years of experience, and productivity, according to a new study published online August 15 in the Postgraduate Medical Journal.

After adjustment, the overall reimbursement differential against female providers was −$18,677.23 (95% confidence interval [CI], −$19,301.94 to −$18,052.53). "Of the 13 specialties, only haematology and medical oncology had differentials that were not statistically significant," write Tejas Desai, MD, from Hefner VA Medical Center, Salisbury, North Carolina, and colleagues.

Decades of research have highlighted the existence of a gender pay gap, even among physicians. Indeed, a recent study of academic physicians' salaries in the United States showed that female physicians earned about 8% less than their male colleagues, amounting to about $20,000 less per year.

However, many of these studies either relied on self-reported data, which may have introduced bias, or did not adjust for factors that may affect physicians' income.

With this in mind, Dr Desai and colleagues conducted a study of gender income differences by analyzing objective, non-self-reported Medicare Part B reimbursement data for 2012. They compared the reimbursements made to female and male physicians in 13 medical specialties for more than 3 million claims.

The largest gap across the 13 specialties occurred in nephrology (−$16,688.96; 95% CI, −$21,437.04 to −$11,940.88), followed by rheumatology (−$15,405.54; 95% CI, −$21,832.93 to −$8978.15) and pulmonary medicine (−$11,017.79; 95% CI, −$13,442.74 to −$8592.84). The smallest gaps occurred in medical oncology (−$3970.50; 95% CI, −$13,903.06 to $5962.05), gastroenterology (−$4636.67; 95% CI, −$5761.80 to $3511.55), and critical care (−$4360.05; 95% CI, −$8184.85 to −$535.24).

Although the results of this study do not explain why reimbursement is lower for female physicians compared with male physicians, they rule out commonly held theories that pay gaps result from women working fewer hours or being less productive than men.

The authors therefore emphasize the need for further research to uncover the reasons for this gender pay gap. In addition, although they analyzed Medicare Part B data for their study, they have no reason to believe that this pay gap exists only in this particular data set.

"Using objective, non-survey data will provide a more accurate understanding of this reimbursement inequity and perhaps lead the medical profession (as a whole) towards a solution that can reverse this decades-old injustice," the authors conclude.

In an accompanying editorial, Professor Fiona E. Karet Frankl, MBBS, PhD, from the Cambridge Institute for Medical Research, United Kingdom, stresses how studies that highlight the gender pay gap "add further colour to a much larger canvas: that of problems with recruitment and retention of women across all science, technology, engineering, mathematics and medicine (STEMM) subjects."

Although some experts say that "[t]ime will cure the problem," Dr Karet Frankl notes that women comprised 52% of her medical school class in 1980 compared with only 13% of her professional cohort today. "We speak of a 'leaky pipeline,' but further discussion often focuses on the water rather than the pipe," writes Dr Karet Frankl.

And although it may be difficult to change the long-hours culture in the medical field, she suggests that increasing flexibility at work or job-sharing might help to reduce the gender imbalance. Supporting women who have caring responsibilities, welcoming returners from career breaks, and mentoring for those at midcareer level, the "leakiest" stage, could also help, she adds.

"One thing that is universal, however, is that there is no single factor that, if fixed, would make gender imbalance disappear," Dr Karet Frankl concludes.

The authors and editorialist have disclosed no relevant financial relationships or conflicts of interest.

Postgrad Med J. Published online Aug 15, 2016. Article abstract, Editorial extract

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