In medicine, men generally earn more than women for similar work, but new data published in BMJ finds that the income gap between genders shrinks substantially in practices with more equal gender distributions of staff physicians.
The analysis showed that in nonsurgical specialty practices with at least as many women as men, men earn 12% more than women. However, that gap nearly doubles -- to 20% -- for practices with more than 90% male physicians on staff.
In absolute terms, this means that in nonsurgical specialty practices with 90% male representation, female physicians earn as much as $91,000 less per year than their male peers.
The study's senior author, Anupam Jena, the Ruth L. Newhouse associate professor of healthcare policy in the Blavatnik Institute at Harvard Medical School, collaborated with researchers from the Rand Corporation, the University of California, Berkeley and Doximity.
They analyzed data from a national survey of physician salaries in the U.S. from 2014-2018 that included 18,802 physicians from 9,848 group practices. They compared earnings across practices with different proportions of male and female physicians, adjusting for physician specialty, years of experience, hours worked, measures of clinical workload, practice type and geography.
WHAT'S THE IMPACT?
The findings offer evidence supporting the notion that diversity in the workplace may have a positive effect on reducing earnings gaps and other inequities.
Research into workplace diversity and income equity has been scant at best, the authors said, in part because it's difficult to combine information about an individual's income and demographic information about their workplace. The survey assigned each doctor a unique practitioner identifier number, which allowed the researchers to compare information about respondents' individual incomes against demographic information about the practices where they work. Doximity conducted the survey and owns the database containing practice demographic information.
Among 11,490 nonsurgical specialists, the absolute adjusted difference in annual income between men and women was $36,604 for practices with less than 50% male physicians, compared with $91,669 for practices with at least 90% male physicians.
They found a similar distribution of incomes among 3,483 surgical specialists, with absolute adjusted gender differences of $46,503 in annual income for practices with less than 50% male physicians, compared with $149,460 for practices with at least 90% male physicians. The relative difference in pay for surgical specialists was 10% in the practices with the most women, compared to 27% in practices with more than 90% men.
Incomes were not affected by gender representation among primary care practitioners. Among the 3,829 primary care physicians in the sample, differences in income for men and women did not vary according to the proportion of male physicians in a practice. The researchers said this was likely because there's less variation in income among primary care physicians. Primary care is among the specialties with the highest proportion of female physicians.
One likely explanation for greater equity in practices with more women was that the experience of working with women might change some of the implicit and explicit biases that many people hold about women in the workplace, the authors found. They also said that women who were hired by practices with more female physicians might face less difficulty negotiating parameters such as how long they are allowed to spend with each patient, how long it will take to become a partner and other factors that impact earnings over the long term.
Authors said that the wage gap would fall by about 20% if practices had more equal gender representation.
THE LARGER TREND
Disparities in physician pay based on gender is unfortunately nothing new, but a report published in January found that the difference is pronounced right from the get-go. As young physicians begin their careers, males on average make $36,600 more than their female counterparts.
Looking at data from 1999 to 2017, the report found that the average starting compensation for men was $235,044. For women, the figure was $198,462. Those numbers are based on survey data from graduating medical residents and fellows in New York.
The pay disparities aren't just limited to physicians. Nurses experience much the same phenomenon.
Even though the proportion of men working as nurses is still pretty small, they tend to make more than women in the same roles, which perpetuates a gender-related wage gap.
Male registered nurses who are on salary made 10% more than women, and hourly male nurses made 5% more. There weren't enough male licensed practical nurses on salary to make a meaningful comparison, but those who were hourly still made about 7% more than women.