An ACC First: Health Policy Statement on Equal Pay, Opportunity

Megan Brooks

September 26, 2019

The American College of Cardiology (ACC) has published its first health policy statement promoting equal pay and opportunity in cardiology — issues that are "critical" to the health and future of the cardiovascular workforce and achieving ACC's mission to "transform cardiovascular care and improve heart health," the College says.

"The College recognized that it needed to be more attentive to the workforce than we have in the past," Pamela Douglas, MD, Duke University School of Medicine, Durham, North Carolina, who chaired the writing committee, told | Medscape Cardiology.

"We've gotten a lot of positive feedback about this document, in particular, and we also hear that it's great the College is stepping up and taking a stand for equity and fairness and creating a level playing field and not being as absent or silent on this issue as we have been in the past," said Douglas.

The 2019 ACC Health Policy Statement on Cardiologist Compensation and Opportunity Equity was published online September 16 in the Journal of the American College of Cardiology .

The medical field, including cardiology, continues to struggle with fair and equitable compensation and with equal opportunity. According to a 2016 study, a $31,749 to $37,717 annual salary gap exists between female and male cardiologists, even after a range of individual, role, and practice characteristics is considered. This amounts to more than a $1 million difference over the course of a career.

17 Principles for Achieving Equitable Pay, Opportunity

The ACC policy statement provides 17 principles for achieving equity in compensation and opportunity, beginning with the declaration that cardiologist compensation should be equitable and fair for equivalent work.

The ACC believes compensation should be objectively determined by a modeled systems approach that is prospectively developed, based on consensus principles, and individualized to reflect performance, productivity, and other prospectively determined factors.

Compensation plans should value and explicitly reward nonbillable work, including quality improvement, leadership/administration, teaching/mentoring, research, community service, and outreach activities. Salary history should not be used in setting cardiologist compensation, the policy statement says.

Compensation plans should include strategies and formulas that offer flexibility to accommodate different job descriptions and should explicitly address and incorporate leave policies. They should also define the activities and behaviors that will result in an increase or decrease in compensation.

The policy also states that cardiology leadership and impartial external experts should regularly and frequently review cardiologist compensation models, metrics, and actual total compensation, as well as access to resources and opportunities.

As part of ensuring opportunity equity, the policy says leadership should be responsible for mitigating the effects of "unconscious or implicit" bias and creating a culture of inclusion.

"It's really all about inclusivity," Douglas said in an interview. "We want to be sure that anyone who wants to be a cardiologist and is capable of being a top cardiologist feels welcome in the profession and is compensated fairly."

An Agent of Change

"This is a very important document. There has never been a comprehensive document such as this addressing compensation and opportunity equity," Dipti Itchhaporia, MD, Hoag Memorial Hospital Presbyterian, Newport Beach, California, who wasn't involved in its development, told | Medscape Cardiology.

"In the past," Itchhaporia added, "individual cardiologists have worked out their compensation without any guidance or documents that have laid out any principles. This will be a very useful document that can guide discussions about compensation, particularly as we are moving to team-based care and moving away from volume to value-based care."

"Change can't happen without a discussion first. This will start that discussion that can lead to change," she concluded.

Douglas and Itchhaporia have no relevant disclosures. Disclosures for the writing committee are listed with the original article.

J Am Coll Cardiol. Published online September 16, 2019. Full text



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