What's the Real Reason Women Docs Earn Less Than Men?

Every year, after Medscape releases the Physician Compensation Report, readers write in with their theories about what's causing the gender pay gap seen in our data.

To many, it's a no-brainer: Some hospitals, institutions, and medical groups pay women less just because they're women. Others argue that gender discrimination is an easy scapegoat and it's not the big factor that it's made out to be.

In our 2019 report, male primary care physicians earned $258,000 to women's $207,000; male specialists earned $372,000 to women's $280,000. The gender pay disparity has shown up in every report since Medscape began producing it in 2011.

Each year, we have looked deeper into our data in an effort to identify relevant factors. This year, we looked at even more factors, filtered data differently, and explored whether our readers' theories had some validity.

Here's what some of you have suggested is responsible for the gender pay gap and what our data show.

1. Part-time vs Full-time

After our 2012 report showed a large pay disparity, some readers suggested that more women than men work part-time, so that's why men's earnings are higher. (In 2012: $242,000 for male specialists vs $173,000 for female specialists; $174,000 vs $141,000 in primary care.)

It's true that almost twice as many women physicians work part-time (24% of women, 13% of men in Medscape's 2015 report); however, in our reports, we filter out the part-time physicians when computing the final compensation numbers. Part-time physicians' salaries are not included in our results. We began to make that more clear by stating it in the slide captions. So, to put that theory to rest, part-time work did not account for the gap.

2. Women Physicians in Lower-Paying Specialties

Another popular theory: More women head for the lower-paying specialties/Far fewer women go into the higher-paying specialties.

That statement is accurate. Among the highest-paying specialties, the percentage of women is generally low: cardiology (12% are women); orthopedics (8%); otolaryngology (14%); radiology (14%); urology (17%). The exceptions seem to be plastic surgery (50%) and dermatology (42%).

In terms of overall total salary for physicians, the gender distribution within specialties does seem to make a large difference.

Digging deeper, however, we looked at male/female salaries within the specialties (those specialties that had sufficient female representation to make the results statistically valid). The pay gap existed even within individual specialties: anesthesiology: $407,000 for men vs $344,000 for women; family medicine: $253,000 vs $201,000; internal medicine: $264,000 vs $214,000; ob/gyn: $336,000 vs $282,000; psychiatry: $280,000 vs $233,000; radiology: $431,000 vs $375,000.

3. Age: Younger vs Older Women Physicians

There are far more women physicians now than there were about 20 years ago: 195,537 in 2000 and 359,409 in 2019 (compared with 644,683 male physicians in 2019).^[1] An athenahealth survey showed that more than 60% of physicians under the age of 35 are female, while just under 40% are male.^[2]

Younger women physicians in general earn less than older women, who have had years to build up their salaries. Might the greater number of younger women physicians have lowered the average salary of female physicians?

When we filtered by age group, we found that within each group—in which doctors were compared only against physicians of their own age—the wage gap still existed.

4. Employed vs Self-employed

Self-employment cropped up as a potential factor. About 23% of women physicians are self-employed compared with 35% of men, according to one of our recent reports. Self-employed physicians earn more overall: $348,000 vs $274,000 for specialists, and $229,000 vs $207,000 for primary care physicians.

When looking strictly at employed physicians, however, the wage gap still existed, so self-employment is not the reason.

5. Numbers of Hours Spent Seeing Patients

Of the almost 20,000 physicians surveyed for our 2019 report, women physicians saw patients an average of 4 hours less per week than did men. (Note that this differs from number of hours worked per week and time spent with each patient.) This statistic was similar to results from a survey done by the Physicians Foundation and Merritt Hawkins, a national physician recruitment firm, showing that women saw fewer patients but did more paperwork.^[3]

This factor might make a small difference for self-employed physicians (the more time spent seeing patients, the more revenue the physician may bring in). On the flipside, more time spent on paperwork could potentially lead to fewer denied claims.

So this metric does not seem to add any information to account for the gender pay gap.

6. Negotiating Skills

There's been some commentary suggesting that "soft skills" or "human" factors might contribute to the pay gap.

The idea is that women tend to be less aggressive than men in negotiating their salary and fighting for a promotion or more pay. Linda Babcock, PhD, professor of economics at Carnegie Mellon University and author of Women Don't Ask, has stated that women often don't get what they want because they don't ask for it. "In three separate studies, we found that men are more likely than women to negotiate for what they want," said Babcock in a Harvard Business Review article.^[4] Medscape has addressed the topic of women's negotiation approach.

While aggressive negotiation may be a contributing factor, many physicians doubt that it's the chief factor.

7. Work-Life Balance vs Bigger Bucks

Are women physicians choosing fewer hours or more flexibility in their schedule (and perhaps less pay) in exchange for a better work-life balance?

Travis Singleton, executive vice president of Merritt Hawkins, says there may be some truth to that statement.

"We have found that the vast majority of the difference in hours spent seeing patients is driven by physicians themselves," says Singleton. "Of the many physicians we work with, and hear what is important to them in a job, more women physicians say it's quality of life and flexibility with their schedule. Males more often say 'income and control over certain aspects of their practice.'

"'Quality of life' doesn't necessarily mean taking care of children," says Singleton. "It means different things to different people, and family time is just one of many things. To others, it means travel, hiking, vacations, or just the decision that for the difference in salary, it's not worth it to them to work 60 hours a week vs 40 hours." Singleton explains that many women knew they would earn less by choosing quality of life and entering work situations that allowed more flexibility as well as more freedom to govern their patient mix.

8. Unfairness in Pay for Women

The gender pay gap has been chronicled in numerous studies over many years—not only among physician groups but in other industries and job categories as well.

Among the many comments we received from Medscape readers were from physicians who were irate that some doctors keep looking for other factors to explain the pay gap rather than just calling it discrimination. Still, it's likely that the factors we investigated have contributed to some degree.

Several organizations, such as TIME'S UP Healthcare, are working to close the gender pay gap in medicine and healthcare. Will our next Compensation Report show an improvement? What's your take on the situation? We'd love to hear from you.

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