The Gender Gap: Pay Disparities Between the Sexes

Female endocrinologists are paid less than their male counterparts and they’re not alone. Will medicine – and endocrinology in particular – ever narrow the pay disparities between men and women as other professions outside healthcare have done?

It is no secret that women are often paid less than their male counterparts in the same position. The Equal Pay agenda has made significant news since the White House first revealed that full-time working women earn only about 77 cents for every dollar a man earns.

The gender pay gap spans across almost every profession and doesn’t skip the salaries paid to endocrinologists. In 2014, male endocrinologists earned an average salary of $206,000 compared with the $168,000 earned by female endocrinologists, according to the Medscape Endocrinologist Compensation Report 2015.

“There is no doubt that women endocrinologists are paid less than men,” says Mary Lee Vance, MD, professor of Medicine, Endocrinology and Metabolism at the University of Virginia School of Medicine in Charlottesville. “I’ve observed this for over 30 years.”

The trend of less pay for female physicians stretches across all specialties. A 2013 study in JAMA Internal Medicine reported female physicians earned an average $56,000 less each year than male physicians — a gap that researchers found hasn’t moved since the late 1980s.

Harvard Medical School researchers examined nationwide salaries from 1987 to 2010 and revealed salary earnings of male physicians steadily exceeded female physicians by 25%. Over those same years, however, the salary gap between women and men outside of healthcare shrunk from 28% to 15%.

“There is something that’s intrinsically going on within the physician workforce,” study author Anupam Jena, PhD, told Reuters.

“Alternative Factors”

When the White House released the National Equal Pay Task Force report in 2013, several articles were subsequently issued that offered the counter-argument. The consensus was that while there is indeed a gap in salaries between men and women, the gap wasn’t nearly as great as 77 cents on a dollar.

Some economists and policy analysts also argued that “alternative factors” should be recognized as the reason for pay differences. Education, choice of occupation, hours worked, experience, and career interruptions all affect the compensation of workers, whether male or female, according to the Equal Pay for Equal Work issue brief released last year by The Heritage Foundation.

Craig Fowler, president of the National Association of Physician Recruiters, agrees and says that in his nearly 20 years of physician recruiting he’s never had a search where less money was offered to a woman than a man for the same job. “Base compensation is always the same regardless of gender,” Fowler explains. “Differences may come into play when it comes to productivity pay.”

“It is possible that female physicians earn less in productivity compensation due to outside responsibilities, such as family and children that pull on their time,” he continues. “Females may not work as many hours as men, therefore see fewer patients and consequently earn less in production dollars.”

“I am not satisfied or accepting of the inequity in salary compared with my male colleagues. This element of inequitable remuneration does impact on the issue of ‘satisfaction,” including my experience. Why are women paid less than men for the same work? There is no excuse for this.”

— Mary Lee Vance, MD, professor of Medicine, Endocrinology and Metabolism at the University of Virginia School of Medicine, Charlottesville

The Medscape report backs Fowler’s sentiment. It noted that women tend to work shorter hours and fewer weeks than men, revealing that 18% of female endocrinologists work part-time compared with 7% of male endocrinologists. Family obligations are the main reasons.

Susan Herzlinger Botein, MD, of Boston’s Joslin Diabetes Center, agrees that working women have more challenges and obligations at home, but acknowledges there are “plenty of stay-at-home dads who allow female physicians who prefer to work full-time to do so.”

“In the absence of that, because of the time demands of paperwork and documentation, ‘full time’ clinical work invariably is completed in so-called off hours,” says Botein. “Due to the demands and pleasure of having a family, full-time clinical work does not work for many of us. I feel fortunate to be able to spend time with my young children and hope that this also makes me a better and happier physician.”

So, does gender discrimination in healthcare play a role in salary differences or career advancement? Most female physicians say yes. Rock Health, a healthcare venture funding group, surveyed 400 female physicians and found that women feel gender continues to hold them back. In fact, 96% believed gender discrimination still exists. In Rock Health’s “The State of Women in Healthcare,” 40% of female respondents also believed their firms do not support women in career development.

Would you do it all over again?

The Medscape report revealed other facts about the endocrinology specialty. Endocrinologists are among the lowest-paid physicians, ranking third from the bottom. On average, endocrinologists earned $196,000 annually — placing the specialty just above family medicine and pediatrics as the lowest wage earners.

Where endocrinologists work does make a difference in earning power. Those in office-based single-specialty group practices make the most ($222,000), with endocrinologists in outpatient clinics ranking second at $208,000. Those in the specialty earning the least are in academic or government settings (186,000) and hospitals ($162,000).

With these numbers in mind and noting the gender pay differences, only 38% of female endocrinologists reported being satisfied with their income — lower than the 45% reported by their male counterparts.

“I am not satisfied or accepting of the inequity in salary compared with my male colleagues,” says Vance. “This element of inequitable remuneration does impact on the issue of ‘satisfaction,” including my experience. Why are women paid less than men for the same work? There is no excuse for this.”

But if they had to do it all over again, 63% of endocrinologists said they would still choose medicine as a career, although less than half (45%) would follow the path of endocrinology once more.

“I think that physicians who would not pursue their specialty are dissatisfied with how their choice fits into their lifestyle, such as the time demands, administrative burden, and income,” says Herzlinger Botein. “These factors are, appropriately, not the focus of medical school and residency but can be a surprise.”

“Further, peoples’ lives change quite a bit in their 20s and 30s, when these decisions are made,” she adds. “It’s easier to say ‘who needs money? when you are single without children. I have not second-guessed my career path into endocrinology.”

Women in the Medscape survey also differed from men when describing what they find most rewarding about their jobs. Among endocrinologists, 42% of men and 36% of women believe that relationships with patients are a major source of satisfaction.

Vance says that she is very satisfied with her career in academic medicine and finds patient care and education of the medicine residents, medical students and her endocrine fellows most rewarding.

Herzlinger Botein agrees. “I feel fortunate to have chosen a specialty that I find intellectually satisfying and allows close, long-term relationships with my patients. That my job fits into the structure of my family life is not accidental.”

Fowler says for female physician job seekers who are looking to leave a current position, the main reason is to be closer to family. “Secondly, I see improved quality of life as another reason, such as hours, call schedule, and volume of patients.”

Glenda Fauntleroy is a freelance writer based in Carmel, Ind., and a regular contributor to Endocrine News. She wrote about hypophosphatasia in the August issue.

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