The Time for Gender Equity Is Now, Says ACP

Marcia Frellick

April 21, 2018

NEW ORLEANS — Equitable pay for men and women, increasing the number of women in leadership, and investing in research on the consequences of gender compensation inequity are just a few of the proposals outlined in a position paper on gender equity issued by American College of Physicians (ACP).

Although the elimination of gender bias has been a longtime ACP goal, "now we're trying to get practical and real," said Susan Thompson Hingle, MD, who is chair of the ACP board of regents and lead author of the position paper, which was published online April 17 in the Annals of Internal Medicine.

The recommendations, discussed during a news conference here at the ACP Internal Medicine Meeting 2018, also include making sure that no physician is penalized for working less than full-time, researching barriers to career advancement, and implementing regular implicit bias training for all organizations that employ physicians.

According to the Medscape Physician Compensation Report 2018, which compares only full-time compensation, female primary care physicians earn 18% less than their male counterparts ($203,000 vs $239,000), and female specialists earn is 36% less ($263,000 vs $358,000).

For internists, women earn about 16% less than men ($210,000 vs $244,000).

The pay gap persists in all areas of medicine, including academic medicine, said Sue Bornstein, MD, an ACP regent from the Texas Medical Home Initiative in Dallas.

"These gaps persist even after we adjust for factors such as specialty, place of employment, years out of residency, and even actual hours worked. So we know there's something more going on here, and we need to know more about what that is," she explained.

The position paper also puts forward a strategy that involves a minimum of 6 weeks of family leave for physicians, residents, and medical students, and 6 weeks of paid leave for physicians and residents.

Leave for Medical Students Will Take Balance

For medical students, 6 weeks of medical or parental leave will require a delicate balance between training needs and life requirements, ACP leaders acknowledge, and there are still questions to be answered.

"Our educational programs are designed to teach a lot in a short amount of time. If you take out 6 weeks," Hingle asked, "how do you address the educational needs?"

The leave recommendations will likely also be hard for private practices.

In a four- or five-person practice, another physician would be needed to cover that extra work, noted ACP President Jack Ende, MD.

"It's a challenge, but it really is a challenge we must meet," he said. "We are the only industrialized nation that does not have that as a requirement."

"These are not going to be easy conversations," said Darilyn Moyer, MD, executive vice president and chief operating officer of the ACP. "They are very complex, but they are very needed."

Disadvantageous Pay Structure

The payment structure in the United States is disadvantageous to women physicians.

Women tend to see a larger percentage of female patients, and comprehensive women's healthcare can include items such as a pelvic exam, a Pap test, health screening, and discussions about human papillomavirus vaccine, Bornstein explained.

As a result, visits for women are longer than they are for men, "and, I would argue, more comprehensive," she explained. "The net result is that women typically take — even in a routine visit — up to 2 minutes longer per visit."

Shifting to a value-based care system would help reduce that kind of disparity, she told Medscape Medical News.

The recommendations could backfire and lead to unintended consequences, Molly Carnes, MD, from the University of Wisconsin–Madison, writes in an editorial accompanying the position paper.

"If ACP's statement spawns interventions interpreted as externally imposed, they can incite hostility toward the perceived source of pressure (that is, women)," she explains.

That is why all physicians must work to put these recommendations into action.

"The best people to lead this are the people in the majority," Moyer said.

It is important to remember that these discussions are not about whether one woman should make more, but about "individuals who really want to help organizations reach their full potential," Hingle pointed out.

Physician pay inequities persist despite 50 years of federal law mandating that men and women receive equal pay for equal work.

This position paper "is timely and commendable but will not guarantee gender equity," Carnes write. "After all, physician pay inequities persist despite 50 years of federal law mandating that men and women receive equal pay for equal work."

Two things are converging to make the timing particularly right for movement on gender equity. One is the movement nationwide, in all industries, to eliminate gender disparities, Bornstein said.

The other is that, in December 2017, for the first time, more women than men entered medical schools, she reported.

Bornstein, Hingle, Ende, Moyer, and Carnes have disclosed no relevant financial relationships.

American College of Physicians Internal Medicine (IM) Meeting 2018. Presented April 20, 2018.

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