Newly trained physicians who are women are being paid significantly lower salaries than their male counterparts, according to a new study published in the February issue of Health Affairs, released today. The authors identify an unexplained gender gap in starting salaries for physicians that has been growing steadily since 1999, increasing from a difference of $3,600 in 1999 to $16,819 in 2008. This gap exists even after accounting for gender differences in determinants of salary including medical specialty, hours worked, and practice type, say the authors.
The authors based their conclusions on survey data from physicians exiting training programs in New York State, which is home to more residency programs and resident physicians than any other state in the country (1,073 programs, according to data assembled by the Association of American Medical Colleges). The number of physicians in the survey sample included 4,918 men and 3,315 women.
The study findings are especially significant since women represent nearly half of all US medical students and are projected to make up about one-third of all practicing physicians at the beginning of this coming decade. Women had lower starting salaries than men in nearly all specialties, according to Anthony Lo Sasso, a professor and senior research scientist at the School of Public Health of the University of Illinois at Chicago, and his coauthors. The gap grew steadily from 1999 to 2008. In 1999, new women physicians earned $151,600 on average compared to $173,400 for men—a 12.5 percent salary difference. That difference grew to nearly 17 percent by 2008, with women starting out at $174,000 compared to $209,300 for men.
“It is not surprising to say that women physicians make less than male physicians because women traditionally choose lower-paying jobs in primary care fields or they choose to work fewer hours,” says Lo Sasso. “What is surprising is that even when we account for specialty and hours and other factors, we see this growing unexplained gap in starting salary. The same gap exists for women in primary care as it does in specialty fields.”
The authors contend that the differences in pay persist even when adjusting for differences in work hours, specialty choice, practice location, and numerous other factors. Potential reasons that cannot be ruled out include an increase in gender discrimination and that women are not as skilled as men at negotiating salaries.
But Lo Sasso believes that the divergence in starting salaries may have more to do with the fact that women physicians are seeking greater flexibility and family-friendly benefits, such as not being on call after certain hours. He suggests that women may be negotiating these conditions of employment at the same time that they are negotiating their starting salaries.
“It may be that lifestyle factors may be increasingly important to newer physicians,” says Lo Sasso. “It could be that women in particular want to have more of a lifestyle balance in their medical careers.”
Historically, women have disproportionately chosen primary care fields such as internal medicine, family practice, or pediatrics. But the percentage of women entering primary care dropped from nearly 50 percent in 1999 to just over 30 percent in 2008. Despite entering higher-paying specialties, the authors found that the widening gap in pay persisted. For example:
- Female heart surgeons were paid $27,103 less on average than males.
- Female otolaryngologists made $32,207 less than males.
- Women specializing in pulmonary disease made $44,320 less than men.
Lo Sasso contends that physicians and specialty groups need to clearly understand what is motivating the gender gap in physician pay and address it, especially given the increased need for physicians, particularly in the primary care field. He cautions that policy makers and physician practices should reconsider how to attract providers, the structure of working arrangements, and how to pay providers.