Women can overcome the infamous “pay gap” through careful job selection, tough negotiation, and providing additional value.
This post touches on a hot topic that many people have very strong feelings about. It can even be a political topic. The likelihood of me not offending someone with this post rounds to zero. However, it is such an important topic that I think it should still be covered on this blog, even if I offend a few people. I apologize in advance. Know that my intent was not to offend you.
The Physician Gender Pay Gap
Most people are familiar with the concept of the “gender wage gap”. This is the idea that women are paid less than men to work the same job. In 2018, this was calculated as 18% using census data, meaning women make 82 cents for every dollar that men make. Even a minimally trained scientist or statistician can see the flaws in that analysis, which are often carried from study to study on this topic. Any honest discussion of this topic must correct that data for those obvious flaws.
The first of these flaws is that women work in different industries and jobs than men. Consider the percentage of female pediatricians (75%) versus female radiologists (27%), not to mention the dramatically more impressive comparison of the percentage of women leaders in investment banking (17%), private equity (9%), and hedge funds (11%) compared to physician assistants (72%) and nurse practitioners (87%). Medicine is actually among the most egalitarian of professions in this respect, with just over 50% of current medical students being women. But any fair comparison of the “gender wage gap” will look at what male internists make versus what female internists make and so forth. Otherwise, your statistics have nothing to do with whether women are paid the same as men to do the same job.
Secondly, one must correct for experience. Women are far more likely than men to work part-time (20% versus 9%) or even take years away from the workplace (38% versus 5% for families with a child under 3), primarily to care for family members and take on additional household responsibilities. All that time away means less experience at that particular job. If you're going to hire someone, do you want the person with 5 years of full-time experience or 5 years of part-time experience? Not a hard choice, right? All else being equal, the more experienced person is worth more than the other to the employer. Plus that person is around more often when opportunities for advancement come up. You can't get the promotion if you're not there and you're unlikely to get it if you are working part-time or have made it clear to your employer that you put your family ahead of your job. (Not that I don't think you should put your family before your job, I certainly do.)
Finally, you must correct for hours worked. An ENT working 55 hours a week and taking two days of call a week and one weekend a month deserves to be paid more than an ENT working 35 hours a week and taking no call. If you work more, you should be paid more. So data needs to be corrected for this before one can identify any sort of gender wage gap. You also must correct for other job benefits. For example, women are more likely than men to highly value a job that offers great flexibility or child care benefits than men are. Those factors usually don't show up in gender wage gap studies.
Why There IS a Gender Pay Gap
There are really two reasons why the remaining gender pay gap exists. The first is that women are far less likely to negotiate hard. Part of that is the fault of women, but a larger part is simply cultural. Men who negotiate hard are viewed as tough and competent. Going for it in a win-lose negotiation is positively perceived in men, but negatively in women, who are expected by culture and stereotype to be more accommodating. As a result, many more women than men (93% versus 43%) of graduating professional students do not negotiate their first job offer at all. Not a single counter-offer. They did not ask for a single additional dollar, benefit, or accommodation. In life, you don't get what you deserve, you get what you negotiate. Women negotiate less often and with less vigor, and that accounts for a significant chunk of the real wage gap.
The second reason is simple discrimination. If you don't believe that discrimination exists despite laws to prevent it, you should review the evidence. KPMG did a study where they calculated that as much as 39% of the wage gap was due to discrimination. They seemed to do a pretty good job in their study, but it appears they lumped failure to negotiate in with discrimination, which I don't think is completely fair. At any rate, hopefully the discrimination factor will lessen over time and I encourage support of political and legal efforts to do so.
Linda Street explained at WCICON21 the importance of negotiating your contracts:
How to Get Paid What You Deserve
With that introduction out of the way, let's get into the nuts and bolts—how can you, as a high-earning dentist, physician, attorney, other professional, or other high earner who happens to be a woman, get what you deserve? There are some useful strategies.
Strategy #1 Know What You Are Worth
I am amazed at how many doctors, male and female, there are out there who have little idea what their unique set of skills and knowledge is worth on the open market. There are doctors out there working for far less than they are worth. For example, I have met a fair number of pediatricians who were earning in their low 100s instead of the low 200s.
So strategy number one is to simply get some knowledge. Know what the other docs in your hospital and your department are worth. At many state universities, this is public knowledge. It's on the internet. Look it up. Look at salary surveys. Get the MGMA data. Hire a contract review firm that provides this data. Talk to colleagues across the country. Ask your co-workers in private what they make. Straight up ask your boss what your peers are paid for doing similar work. In any negotiation, the person with the most information usually wins.
Strategy #2 Actually Negotiate
Just like the last tip, this one applies to men and women equally. 93% of women coming out of training don't negotiate at all. At all. Just asking for one extra thing puts you in the top 7%! So do it. Read a book on negotiation. Hire someone to negotiate for you. Whatever it takes, just do it. If you're worried about looking like you're not a team player or that you're going to be viewed as money-hungry, remind the person you are negotiating with (and yourself) why you are doing so—to pay off student loans, support your family, support your favorite charities…whatever. View a negotiation as a chance to win a ball game like the men do, rather than a chore to complete like going to the dentist as most women do. Harvard Business Review gives the following tips to women going into a negotiation:
- Prepare fully
- Cultivate positive emotions
- Boost emotional intelligence
- Negotiate communally
- Negotiate a package
Be confident. You're a doctor. You're the one with the rare, valuable skill. You're the one who gave up her twenties to acquire a very particular set of skills.
I don't mean to be condescending with this strategy, but if you don't negotiate, you're not going to be paid as much as someone who does. That's just the way the world works and it isn't going to change any time soon.
Strategy #3 Don't Work for Someone Who Discriminates
Talk to other women who work for a potential employer or your current employer. If they're all being discriminated against, go somewhere else! That employer will end up paying more for their labor and end up with a less diverse workforce until they learn their lesson.
Strategy #4 Decrease the Possibility of a Gap
Many employers have a standard pay scale that is actually standard. Everybody gets paid the same or is paid based on years of experience or whatever. The military is perhaps the prime example here. I knew what every one of my active duty co-workers made. All you had to do was look up the military pay chart. You know their rank and how many years they've been in and their specialty and voila, there's their pay right there. Exactly the same for men and women.
If you're a major with 6 years of service, you're going to make $6,599.10 a month no matter your gender.
The VA uses a pay range, but at least it is published, and you know what it is. You can go to Australia, too. They have a doctor's union there and unions have been shown time and time again to reduce the gender wage gap. Universities that publish salaries are less likely to discriminate against women, too (because that discrimination is so easy to spot).
Strategy #5 Get More Education
As a general rule, the wage gap decreases with more education. Whether that applies to doing “one more fellowship” nobody really knows, but it could help. If you're the only sub-sub-sub specialist in town, it's harder to underpay you relative to peers since there are no peers! Medicine is not the most free market in the world, but supply and demand still have their effects.
Strategy #6 Own Your Job
One of my favorite strategies is to simply be an owner of your own business. You're not going to discriminate against yourself. In my physician partnership, we get an Excel document every month from the managing partner showing all of our income and expenses and we see who gets the rest of the money. The women in the group get paid exactly the same as the men—the remainder after expenses is divided according to the number and type of shifts worked. Medicare, Medicaid, Worker's Comp, insurance companies, and patients themselves don't generally pay differently for services rendered by women versus men. There are many more benefits of ownership beyond the lack of discrimination. I'm a big fan.
Strategy #7 Deliver
You will feel more confident in a negotiation, and your boss will be more likely to pay you more when you are the best of the best. Working harder, more efficiently, more creatively, etc. goes a long way toward increasing your value. Consider one of my partners. He is always available to swap a shift and take on a leadership or committee role. There is real value in that. Keep track of your accomplishments during the year so you can remind the boss at negotiation time of just why you deserve to be paid better than anyone else.
Strategy #8 Build Support at Home
One of the reasons men can often focus more time and mental energy on work is that their non-work needs are often being taken care of by someone else, often a stay-at-home partner. That additional time and flexibility is more valuable to an employer. But there is no reason you cannot also provide it, especially if you are also the primary breadwinner. It will likely require a discussion with your partner and even children. They need to understand that bringing home the bacon is a very important function in the family and that they need to take on some non-traditional roles in order to allow you to do that to the best of your ability. Too many doctors put in 12 hours at work and then have to swing by the grocery store, cook dinner, do the dishes, fold a load of laundry, check on the kids' homework, and then collapse into bed for 5 hours of sleep interrupted by two calls from the ED while their spouse is watching football, drinking beer, and sleeping comfortably. Fix that problem, and the family will likely be paid more for doing so. If your partner is also working hard, consider hiring out some help. You may end up being paid more than that help even costs you!
The gender pay gap may not be as large as many studies would lead you to believe, especially among doctors, but it still exists. Implement these strategies to minimize or even eliminate it from your life and reap the benefits of earlier financial independence.
What do you think? What have you done to make sure you get paid what you deserve? What tips do you have for women earning less than they are worth? Comment below!
One source of gender wage discrepancy in medicine is built into our RVU compensation system. Female surgeons may be more likely to specialize in procedures that are performed on women. Those procedures tend to be valued less than procedures performed on men. For example, female incontinence or prolapse procedures pay less than prostate operations. In general surgery, breast surgery is widely seen as poorly reimbursed. This extends even to the anesthesia codes for these respective procedures. So a female surgeon, by choosing to specialize in treating other women, may be choosing to earn less. How can that be remedied?
Interesting. Wasn’t aware of that. That’s a real systemic issue that would likely need to be addressed at the RUC level.
This is 100% a systems level problem that needs to be addressed. There’s also data to support that the predominance of women in a specialty leads to a decrease in pay for both men AND women (though women >men) who practice in that specialty (ie OB/peds are good examples)
Great comment Jared. It’s multifactorial – this is one of them.
Jared is correct. This RVU discrepancy extends in to pathology CPT coding as well. A ovarian resection for tumor is coded 1 tier below a testes resection for tumor. A simple mastectomy for malignancy is coded 1 tier below a prostatectomy for malignancy. So pathologists who specialize in “women’s health” will start off with a lower RVU exchange rate for many (though not all) specimens.
I am glad that this was the first comment, as it underlines how pervasive this is. Because the discrepancy is everywhere, it’s seemingly nowhere all at once. The discrepancy has been baked into the system at multiple points, and as we untangle it, we start to see how pervasive it is.
Are there pathologists that specialize in “women’s organs”? I guess I didn’t realize the field was so subspecialized.
Yes, pathology has become increasingly subspecialized. In many academic centers, there are pathologists who specialize in only breast, or only prostate & bladder, or only medical renal (not even neoplasms!), or only dermatopathology. And they are busy enough to spend their entire career looking at one organ. This isn’t the case yet in most private practice, so your overall RVUs probably even out over a large number of cases. But as technology improves and physically being located at the same site as the surgery center or OR becomes less of an issue, I can see telepathology driving subspecialization, and the RVU differences will start to become even more apparent.
Totally agree. A vulvar biopsy gets about 1/3 as many RVUs as a scrotal biopsy. I’m expected to do more and more and more care under the “global” fee for the ENTIRE PREGNANCY AND DELIVERY and I still get paid less than the anesthesiologist does to do the epidural. Additionally, even within an OB group where we are each paid the same amount per RVU, the male docs tend to see more patients because they can get away with quicker visits.
LizOB hits this nail on the head. There is bias in RVU/CPT system of payments. When I completed by OB/GYN residency in the 80s the field was still male dominated. It was also one of the higher paying fields. Reimbursement for a delivery was higher in the 80s for a delivery. It seems that the pay scale declined as the speciality feminized. Can I prove this? No but I think it is true.
It’s written up here: https://journals.lww.com/academicmedicine/fulltext/2020/10000/when_a_specialty_becomes__women_s_work___trends_in.18.aspx
You’re all looking at this from the supply side. On the demand side, if it is less expensive to get women’s services, then female patients are getting a better deal than male patients. So if you solve this problem for women, then you might just create a different one.
While I appreciate the acknowledgment of pay discrimination, it seems to be oversimplified here. Not only do you get paid less, you are viewed as less valuable, which can affect team dynamics. For example, I worked at previous employer who offered the men hired after me $20K more after I negotiated fair market value for myself, with less experience! Needless to say, I soon left and now own my own practice. But this practice is quite prevalent in many regions of the country and shouldn’t be glossed over.
Just 5 years ago when I was interviewing for my 1st attending job, I was offered a pre-negotiation base salary that was 30k less than a male co-fellow who interviewed there for the exact same job. Needless to say I did not choose to join that practice.
The discrimination toward minority women is even more. I am a South Asian female. If I even try to ask for more money or benefits…..using the tools you listed above (denoting my accomplishments, etc.)…I am told I am too “aggressive.” I have so many horror stories!!
Meanwhile the Caucasian male doctors at my workplace are blatantly rude and aggressive, to staff and even to patients and they are the ones that are valued , paid more, given “work from home days” etc.!!!
[Political comment removed]
I really like my job…am highly specialized and have not found another place I can do the same things
Good article. It would be interesting to see a study on pay gap for different physician specialties. I’m EM and I would think that there is less of a pay gap in EM, but that’s just my own experience. I work as an independent contractor and our pay rates/contracts are standardized for our entire group. I choose to work part time, but I know my hourly rate and RVU rate is the same as all the other docs I work with. The extremely low percentage of women that negotiate their contracts is alarming though. I was taught in residency some about reviewing and negotiating contracts and therefore thought of negotiating a contract as something that was expected of me. I went to a very male dominated residency though, so that may have contributed. I was able to negotiate sign on bonus, student loan payments, and also a retention bonus a few years later. I’m also in a leadership position so working part time and being a woman hasn’t hurt me there. Working for a large contract group has is difficulties, but on further reflection perhaps it has helped to eliminate some of the gender wage gap and discrimination I may have otherwise experienced.
I work for the state and my colleagues and I are all paid the same in my facility (similar to the salary transparency you get in the military). I make as much as a coworker who has been here for 17 years. We get the same COL increase yearly. Where the difference lies is in vacation time, which you earn with years employed so while I get 28 days a year, others get up to 40 days a year depending on years of service. Yes, paid time off is a form of compensation, but seems more fair to me to give PTO than just pay others a higher salary for more years of service since we all do the exact same work here. Plus it is an incentive for doctors to stay in the position since they will bump up in PTO level every five years. Those days off can be worth more than gold!
Via email:
This was an excellent article! It covers many of the points I’ve been making for years! As a retired female accountant and CPA, I’ve seen my share of what I call opportunity discrimination, particularly early in my career, which impacted pay. Not being considered or offered more challenging assignments even before I married and had children but especially afterwards resulted in less pay and less experience. And it doesn’t affect just women but also minorities of course
We have to continue to demand and take on those opportunities and get the support we need outside of work which will take time because of required shifts in cultural norms. I had many sit down labor strikes at home!! It won’t and hasn’t happened overnight but it is happening! I’ve seen incredible changes since the 70s when I was point blank told I couldn’t have certain jobs because they were too hard or that bankers preferred not to deal with “professional” women!! I can only imagine what happened behind the scenes that supervisors and employers didn’t bother mentioning.
With more understanding of the issue we will have more awareness. And with more awareness we can influence change. Thank you for being part of that process.
The physician gender pay gap is a myth. I’ve never met a physician who was paid based on gender. The salaries at every institution I worked at are based on experience, specialty, and market conditions. THE GENDER PAY GAP IS A MYTH. I’ve worked in 7 different states and men and women were paid EQUALLY!
Thanks for your feedback, but I disagree. While not as large as some poorly done studies say the gap is, I’ve never seen any well done study that suggested it didn’t exist at all. Do you know of one?
Boomer should publish these findings, err anecdotes, in order to help refute literally every other piece of evidence that demonstrates the reality of the gap.
I mean…there is objective research on this topic which is publicly available for you to read. I’d suggest you go read it. Your anecdotal experience of equal pay (which, unless you actually saw their pay stubs, you cannot be sure of) does not outweigh actual objective evidence of systemic unequal pay.
Via email:
“Providing additional worth” is absolutely not overstocking a pay gap. That is literally the definition of doing more for less.
Signed, a high net worth woman
Valid criticism. Perhaps I should have phrased it “make sure you’re providing just as much value to the employer.”
Let’s not forget the well known automatic “gap-creator” in outpatient medicine. Female physicians tend to end up with the more challenging patients (time-consuming, “needy”, complicated) for a variety of reasons – usually because of patient preference, listening skills, demeanor, etc. This by definition will make these physicians comparatively less productive.
Similar if they can’t have the same expectations of support staff that their male counterparts do. Can’t tell you the number different work environments where I got push-back and negative feedback from staff just for making routine orders and requests that the men would make all day without a word. That stress and internal conflict also leads to less productivity.
Interesting. What’s your recommendation for dealing with those two issues?
I kid that a colleague (captive patient base) is grumpy. But actually she isn’t to patients, only to staff (strategy of several male colleagues as well but no one tags them as grumpy). Wish I had followed her example and demanded more from my staff- sadly I drifted into the position offering to be flexible and that just continued- gee no one wants to work with this support staff/ patient, see what you can do Dr. Jenn.
While I never succeeded at not being the caring; take the time needed doctor, those female docs who ‘act like men’ as if they are on a tight schedule and their time is very valuable might lose some patients, but won’t miss any of those they lose. Every once in a while I was this to the ludicrous anxious patients we got sick of; they started settling down and getting their excess emotional needs met elsewhere than from me and my team (although BZD therapy played a role in a few patients). Had I needed to stay longer (I just retired rather than tried to fix all the irksome issues of that job) I was working on implementing various maxims like ‘you need someone with more time than me. I’m referring you.’ and ‘remember none of these want 30 minutes face to face time for a level 2 or 3 problem would ever pay out of pocket the $200 it costs my institution for me to provide care for that long.’ and ‘remind staff who ask me to take on a troublesome (emotionally or clinically), or extra when we get no extra pay for additional appointments, patient that I will be quitting if my work days are 1-3 hours longer than all my colleagues’ days.’
These are intriguing points. Do you know if this has been studied?
Regarding what to do: cash based practice where you charge by time allows one to get paid for spending time with patients– not for everyone but at least merits consideration
I agree with you Snag75. I am a female Family Physician, and I know I attract the “needier”, more difficult patients, and the patients who are more talkative, and require more time. I know I spend more time with each patient than male doctors do in general because my patients tell me this all the time. Is this a bad thing? Should I cut people off more? I feel I am spending the appropriate amount of time with them and that most other, male doctors do not spend as much time as they should. This makes me less productive and I earn less. I think patients themselves expect different things from female physicians than from male physicians, such as better communication, more of a relationship, and more time. I am sure that I have read some articles that shows this to be true.
Hi Jim,
Thank you for your post. Love the Gandalf the Gray reference.
I am a female cardiac surgeon, and I worked at an academic institution for 6 years in which I was the only female. I did negotiate my initial offer successfully, and ended up with about a 10% higher salary than initially offered.
After I was hired, though, I was always the least paid, and I always assumed that this was because I was the ‘new guy.’ Until they hired a new guy who was fresh out of fellowship and who had no specialty training, and they paid him 20% more than what I was making! I was the second most productive surgeon in a large group, and I had great outcomes. The only reason they paid me less is because I am female, and simply put, they didn’t think I was worth it. So I let my legs do the talking and got outta that place, and into a much better situation.
I, too, agree that one should make oneself irreplaceable to the institution, and this in itself will justify your ask for more compensation. However, the problem with discrimination is that the powers that be do not see that you are irreplaceable. You are invisible to them. I will also say that women bring a whole bunch to the workplace that is simply not compensated. I easily spend 4 x more time with my patients and their families than my male colleagues, educating, building relationships and counseling. Women as a whole are much more detail-oriented and much more adept at seeing how the small pixels make the big picture. Unfortunately, the dunces in charge don’t often see how valuable these (and other) ‘female’ skills are. I know that patients LOVE having female physicians – it is the biased institutions that don’t.
Thanks for letting me say my piece. It upsets me to no end that I am not viewed as being worthy of an equitable salary. Thank you for trying to help.
Best Regards.
This is a complex issue. I worry too that business owners/managers are being demonized unfairly.
Not everybody liked the post. This negative feedback from a guy came in via email:
Normally, I love your posts. But this is the most sexist, shallow, uneducated piece of writing mansplaining the wage gap from a position that drips with unearned and unacknowledged privilege that I have ever read. You might want to ask yourself why some women work part time and the men work full time. It’s usually to support some entitled husband’s career ambitions at the cost of their own while not sacrificing their family’s well being. (note this isn’t personal for me, I have a wife who does her fair share). Data supports that even men who think they do 50% of the work at home, do closer to 30%. I think you’ll find our unmarried young female peers don’t work part time. Why are radiologists paid more than pediatricians? Why do we value roles that are traditionally masculine by assigning higher monetary value to them over traditional female caretaker roles? Not to mention, the way that women are perceived at work is completely different and the same ideas might be shot down from a woman’s mouth and put in action when verbalized by a man. Your article pays mere lip service to discrimination while effectively blaming women for not earning the same as men. It’s frankly disgusting. Read some books, talk to some women and actually listen to what they feel the problems are before you attempt to explain a situation you clearly do not comprehend.
Perfectly stated.
I am glad you are posting this email reply in the comments.
I wouldn’t say *the* most sexist, shallow, and uneducated, but it’s *pretty* shallow and does miss the mark on multiple points. The assertion that simply starting to negotiate would alleviate the wage gap is only the first step. Even after negotiating, salaries do not rise at the same rate. Brandishing the absolute number of the wage is meaningless without knowing other factors such as number of hours worked, speed to and ease of achieving promotion or partnership, job security, and whatever else.
Anonymous Email Commenter is right about the reasons women “choose” to work part-time or take a non-partner track. It’s not really a choice. If one person in a heterosexual nuclear family makes more income, and if the system is geared to reward the husband most of the time, then the dispassionate and objective choice should be to put your family’s resources in having the husband work full-time at an ambitious career and the wife work part-time for child/home-caring flexibility. But to call it a woman’s “choice” assumes an equal playing field and no other influences other than work, and that is simply not true.
Anonymous Email Commenter also brings up the excellent point that workplace dynamics, largely untouched in this blog post, but which informs the wage gap. There is a fundamental difference in the ways that men and women are expected to behave, which results in differences in promotion, wages, benefits, and perception.
Jim, I think this is one of your blind spots and to your credit, I think you know it. I am a long-time reader and podcast listener. I’ve seen your general movement towards understanding, but I don’t think it’s there yet. It’s clear to me from reading the comments that many people are even further behind. The inequity is woven into the fabric of our lives. I hope you and the readers keep pulling at this string and following to the natural end — that the notion that women going up against the machine and winning one by one, is a false quest that frankly absolves everybody else of responsibility.
well said. Especially “that the notion that women going up against the machine and winning one by one, is a false quest that frankly absolves everybody else of responsibility.”
I think there are some very fair criticisms here. When I read the article I found myself doing quite a bit of internal cringing, knowing what my wife would say if she were the one reading it. I think it definitely came from a good place and wanting to help, and there is helpful information in there, but I do think having it written by a women with practical experience in that arena would have brought helpful insight.
We’ve certainly never turned down a guest post written by a woman on this topic. Guidelines here:
https://www.whitecoatinvestor.com/contact/guest-post-policy/
Please pass them on to your wife. But it’s a topic I think needed to be hit and when I can’t find anyone else to write it….
There are actually many studies that have been done that show there is no gender pay gap. Here is one from Harvard:
https://scholar.harvard.edu/files/bolotnyy/files/be_gendergap.pdf
There area a couple of great economists, Dr. Thomas Sowell and Dr. Walter Williams who have also written on the subject and have found the same thing, that choices women make account for the pay difference. I haven’t seen any studies specific to medicine. Certainly there are personal anecdotes that women experience as described above, but who knows what the real circumstances were. The woman CT surgeon stated that she spent 4x more time with her patients than the men, did that result in decreased productivity?
In my field of practice and in my group the women earn the exact same money as the men. I’m sure there are some outlier practices where gaps exist but I don’t think its the norm.
I’m sorry but that article did show that there was a gender pay gap, but it was explained by the choices that women make. The article talked about female bus drivers and train operators , not female physicians. The women in this study chose schedules that paid them less because they chose schedules where they did not have to work nights, weekends, or holidays. Why do you think they made these choices? Because they are responsible for taking care of their kids, much more than men are. They can’t work nights, weekends or holidays because their children are not in school or daycare during those hours. Saying that women could make the same money if we just made the same choices as men, is victim blaming. I know that I have made choices in my career that caused me to make less money, but I felt I needed to make them so that I could be there for my family.
So you are saying that women should be able to have off nights, evenings, and weekends while men should have to work those shifts but men and women should be paid the same money or this is unfair? It seems that your argument is more along the lines that men and women should divide up responsibilities at home in a more equitable way, not that there is a gender pay gap.
See Comment #11 above
What MLC0707 means, is men should continue equally to child care and running the household and and allow women to do more nights, weekends etc and then see where they stand. Jeesh! If men were taking care of the kids and household management, they could be the ones off on weekends and the women could be working instead, and the pay gap would be reduced.
Fantastic article and comments. I think your article is fair and balanced. Thanks for addressing some of the nuances as there are many.
The only heading that struck me as less than factual was to “actually negotiate-“ many women do negotiate and are penalized for it. I was literally called greedy when I did.
But to your point about knowing your value- I knew the discrepancy between the salary I was hired at and what I wanted to be earning within a 5 year plateau, so I set a calendar reminder to renegotiate every year. I was going to keep asking for more comp until I got there. I felt like a bulldog, but I knew that letting them just pay me what they figured was fair for a lady wasn’t going to work. The pain of negotiating and the risk of backlash is less painful than being taken advantage of.
Thanks for writing about the pay gap as real. Medicine is such a backward field for women in some respects (despite women dominating the base of the pyramid in nursing and so on). There are some who refuse to acknowledge the pay gap exists. And as we become increasingly corporatized, I hope this will mean more standardization of salaries. On the other hand it could mean more taking advantage. I choose to be cautiously optimistic at this point.
I don’t think the corporatization is helping. I suspect it is making it worse. At best, it’s lowering everybody’s income.
A lot of the criticism of this post is because it doesn’t address the systemic issues behind the discrimination. But the post is about what any given high earning woman can do personally about it, not what society should do about it.
Equality is such a complex issue with so many factors involved. There are the systemic issues that need work, the individual issues, and then there are the factors that exist that cannot be changed.
Our medical group grew over time. In the beginning it was very organic. In the early years, we often paid people what they asked for, what they negotiated for, or we simply gave them a raise from what they had previously been paid to entice them to join what we felt was a group with a fair and respectful culture that highly valued all members of the team. We thought we were being fair, but when we looked deeper, we were wrong. We were not being fair.
We eventually created a grid of experience and skills, and created differentials for nights and weekend call. It was pretty shocking to us when we sat down and looked at all of it objectively. The salary grid indicated the women were being paid less, and for the minority women, pay was the lowest. It was quite the shocking revelation. We previously thought we cherished and treated everyone with great respect. We had no concept that we had a systemic pay gap until we pulled back the covers and took a closer look.
We needed to change. We made a concerted effort to equalize pay based on our salary grid. There has been much progress. We also have made a concerted effort to recruit and promote talented women into leadership positions. The funny thing is, despite now having an equal number of women in leadership, more of the men work in administrative leadership positions and more of the women have gravitated to the educational leadership positions. And among the residents, the men gravitate to doing the administrative elective and the women gravitate more towards the educational electives. We are working on looking at these differences to see if it is structural.
At the same time, more women end up taking more time off of work. We give extra support for both maternity and paternity time, but we give more financial support to the women as they are the ones who go through the medical aspects of bearing children. We have greatly enhanced our short term disability coverage to offer better support to the physicians who bear children. In the end, there is one thing you cannot equalize, the men don’t have a uterus, so some of the differences are biological and this does have secondary effects in the workplace.
Have never seen a job in medicine where comparing the same job in the same place, where there is a pay gap. Seen 3 anesthesia groups now, 1 academic, 2 private. Same contracts, pay, incentives (for all employees hired, every group). The guys all pick up weekends, holidays, and work their vacation days. The women in every single group have given away their weekends, holidays, and calls (and the money that comes with them). Of all my med school friends over the years that work with women in their group, they all have the same contracts, same rate of reimbursements, and same salary schedule. They make more by working more, seeing more patients, doing more procedures…period. None of them have a 23% bonus penis clause in their contracts.
I dont even want to hear about specialty X vs specialty Y. We all know how much the stuff gets reimbursed, pick your poison and lifestyle. Frankly it still comes down to women choosing specialties and groups that offer them flexibility, more time off, etc.
Control for every variable appropriately (literal same job, in the same location, in the same practice), have the 2 individuals working the same schedule, same amount of calls, and show me a real pay gap. Otherwise its frankly people wanting the best of both worlds. The pay of someone working full time (with call) with all the benefits that come from the mommy track.
Ive got hospitalist friends, EM friends, surgeons you name it. Its always the same story. The pay gap comes from choices the individual makes; men and women make different choices frequently.
Funny that the peds hospitalists I know are mostly male, and the outpatient clinic pediatricians are mostly female. Its almost like one of those jobs has a significantly higher acuity, crappier schedule, and worse hours, while one is a more breezy, predictable day job.
You might want to do some deeper thinking into why the ” women in every single group have given away their weekends, holidays, and calls”
Prior post broke, oops.
Pay gap is essentially caused by individuals choices. Even when you consider trying to even things out for women compared to men for the responsibility of physically carrying and breastfeeding etc, this is not fair to women who dont have children. Also, no one made you have children or made your husband not help out around the house.
Everyone wants to have their cake and eat it too. The women who want equal pay want to be able to keep their nights, weekends, no calls, mommy track jobs, and end the year with the same dollar amount as the men they are comparing themselves with that are working those shifts.
I have yet to see a job in medicine where they say “oh a penis, here’s 23% more per shift / hour / call”. I have seen the men in the group take on extra calls, weekends, hours, almost every time. The few scenarios where I have seen a woman in the same job making more money…surprise surprise she was picking up more calls and weekends than her partners.
These choices account for essentially the entire pay gap. Some things are hard to hear and its easier to say “its just not fair! the evil man is cheating and thats how he got more!”
Jordan Peterson had some similar things to say a few years ago. Agree that there are parts of this gap that need to be closed. However, this video was also a little eye opening on this topic.
https://m.youtube.com/watch?v=Xg2psply4no
Kind of a hostile interviewer. I listened to the first few minutes and I’m not sure the interviewer understood the concept of multiple variables.
I don’t know if the interviewee believes that discrimination accounts for any of the gap or not. I think it does, but nowhere near the whole thing.
Most of the pay gap comes down to individuals choice frankly. The loudest that come out against this really are not usually looking for a true answer to solve the problem, they want to say “I was cheated, its unfair, its out of my control” rather than have a concrete solution.
Like on parks/rec where Chris is trying to solve every one of Anne’s problems. Donna tells him: just be quiet, nod, and say “…that sucks”
Interesting how men are so defensive on this subject. Are you worried that something is going to be taken away from you if women are paid more fairly? I personally found that the interviewer from the youtube video that Aaron posted above did a wonderful job. The subject of the interview basically equated feminine qualties to not being successful and being paid less, so basically he admitted that there was a pay gap, he just wanted to phrase it in another way. He stated women tend to be more “agreeable” and that is what causes women to be paid less. Agreeable = pay gap , Women = agreeable, therefore Women= paygap.
You are welcome into my group at work anytime. You will be treated fairly, respected, and appreciated as a colleague. But you wont make the money I make unless you work as much as I work. Take the amount of calls I take, work the amount of weekends/nights I work, and you can have the same amount of money, right down to the penny.
We have 3 women in the group, they all make less. One of them takes no call at all with no weekends, one works part time, the other is a full partner that “buys” vacation weeks and weekends from other partners. Pay gap in full force.
What about my time off gap?
I don’t know if you are doing this intentionally but all your posts on this thread come across as “well women are lazier and work less”. I hope it’s just the way the internet doesn’t provide context, but it’s the tone that comes through in your writing.
You also don’t seem to be thinking about the systemic reasons women might reduce their time at work compared to men.
Here are some good studies demonstrating the physician gender pay gap:
https://pmj.bmj.com/content/92/1092/571
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2532788