• Physician pay gender discrepancies

    I’m a pediatrician, so I work in a a specialty where there are more women that men. In fact, I’ve personally mentored and trained far more women in pediatrics than I have men. Because of that, I sometimes think that discrepancies in pay and such must have ended some time ago. If only there were data to confirm my suspicions.

    Well, it turns out there are data, but they’re not good.

    Recently, in Health Affairs, a study was published on starting salaries for residents leaving training in New York State from 1999-2008.

    The authors abstracted data  from the New York State Survey of Residents Completing Training, which is run each year by the Center for Health Workforce Studies of the State University of New York at Albany. Other than one or two years when funds prevented the survey from being completed, it’s been fielded every year since 1998. The authors were most interested in residents’ starting salary, defined as the self-reported base salary plus expected incentive compensation.

    First, let’s look at the unadjusted analyses. Here are starting salaries, for men and women, in selected physician specialties (I made the chart with their data):

    Not only do women have a lower starting salary overall, they have a lower starting salary in nearly every single specialty.  I took a look in the appendix, and if you include all forty-five specialty groups, women lose in every one but four (general surgery, critical care, gastroenterology, and “other” anesthesiology subspecialty). These four specialties account for only 2.9% of graduating female residents.

    That’s sort of stunning. But, it’s possible that other factors come into play. Maybe all the women chose jobs with fewer hours, or in cheap areas. So the authors conducted analyses that looked at average mean salary while controlling for the forty-five categories of specialty training, race/ethnicity, age, citizenship, foreign medical graduate status, whether graduates had an MD or OD degree, educational debt, Health Professional Shortage Area work obligation, practice type, location type, patient care hours, and year. Did that get rid of the discrepancy?


    The solid lines are the unadjusted analyses. So the controlled analysis (dotted lines) about halves the discrepancy. this still means that after controlling for all those other factors, men still had a significantly higher starting salary than did women.  Not only that, but it’s getting worse. It’s risen from $3600 in 1999 to over $16,000 in 2008.

    The manuscript offers a number of explanations for this; some put the fault on the system, and some try and come up with other factors that could legitimately explain the difference. I’d say that the onus is on the system, however. There’s a discrepancy, it’s getting larger, and it’s not easily explained by any of the usual excuses. It’s time for this to end.

    Apologies if there’a paywall, but here’s the full study: The $16,819 Pay Gap For Newly Trained Physicians: The Unexplained Trend Of Men Earning More Than Women

    • The justification for Affirmative Action in the US is predicated on the assumption that minorities like Blacks, Hispanics and Native Americans have been disadvantaged in their education, beginning in the nursery. Likewise disadvantaged are women, who are not, of course, a minority.

      The logical result of being disadvantaged from the cradle forward is that a typical minority or woman performs at a lower level than the advantaged male, so it is no surprise that men earn more than women in medicine, law, science, technology, math, engineering, haute couture, haute cuisine, cabinetmaking, welding, plumbing, filmmaking and chess. If it were otherwise, Affirmative Action itself would be cast into doubt.

      The lower pay of women could instead, of course, be attributed to their innate inferiority to men. Whatever the case, it cannot be surprising that women are paid less than men at all levels in those professions in which men substantially participate.

    • Women, overall, are inferior to men at medicine. My evidence? Your data. Or they’re inferior at negotiating.

      Just because you can’t identify a cause for the discrepancy, doesn’t mean the cause is ‘discrimination’. Perhaps the reason is positive, and should not only not stop, but increase.

      Did they adjust for class ranking? Or other objective measures that would reveal that the men are, in fact, of a higher quality. Did they even attempt to quantify the quality of the physician? Of course not, because…well, it should be obvious why they didn’t.

    • I will never again pay any attention to doctors carping about student loans.

      First year residents,,, Damn!

    • bill, these are not starting salaries for first year residents. They are starting salaries for doctors who just completed their residency. Although I agree it was stated somewhat strangely:

      “starting salaries for residents leaving training in New York State from 1999-2008”

      I have to assume they mean people that just finished residency because residents make much less money. Much less. Much MUCH less.

      As for why women make less money, I don’t think it’s necessarily discrimination. Studies have shown that women as a general rule don’t negotiate salaries as often as men, or don’t put as much emphasis on their salary.

      • Kevin, I appreciate the clarification. The quote you noted had me confused as did this one:

        “The authors were most interested in residents’ starting salary, defined as the self-reported base salary plus expected incentive compensation.”

        It sounds like the authors were interested in starting salaries as residents but (given your good explanation) they were actually looking at recent residents.

        • Yes, I think it was very confusing the way it was worded. I’m not a doctor but I know some residents that started around $45,000/year. Even by end of residency, they’re still only in the high 50’s. That’s anecdotal of course, but some online searching seems to confirm that that’s normal.

      • Further complicating the negotiation issue, I also saw an article recently (sorry, I could not quickly locate a link) that women are perceived poorly when they negotiation or as for a raise, by both men and other women. So it seems like women are darned-if-we-do, darned-if-we-don’t negotiate for better pay.

    • What would seem to be driving these gaps is the perception of female physicians and the lifestyle choices they might make down the road. In other words, they may get pregnant, have children or otherwise prioritize family over work. It’s the same thing we see in other job markets, so it ought not be surprising. Plus, let’s be honest about the expectations placed on physicians with respect to work-life balance, or lack thereof. Given that reality, should we really be surprised that employers are discounting female physicians’ salaries?

      (That is not to say that I support this wage discrimination, because I do not.)

    • I am an old doc who has been a senior partner in a large medical partnership and hired lots of freshly minted young doctors. There is typically little negotiation because young doctors have little clout; nobody has a star-quality reputation and a panel of loyal patients when they start their career. They may have that later, but not at first. The offers are ” take-it-or-leave-it.” Young physicians typically have little business savvy and don’t know how to negotiate, but young men are typically more prepared to leave for greener pastures. A male physician can convince the significant other to leave her job and move across the country easier than a female physician can convince her spouse to do the same.
      Men have more power in the world, duh.