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.

Once you make these very appropriate corrections, the gender wage gap usually shrinks dramatically in most industries, jobs, and time periods. But it doesn't typically go away completely.


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.

physician compensation

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

gender pay gap

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:

  1. Prepare fully
  2. Cultivate positive emotions
  3. Boost emotional intelligence
  4. Negotiate communally
  5. 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.

military pay

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!