Today on the podcast, Dr. Spath interviews Dr. Shikha Jain. Dr. Jain has devoted her life to practicing medicine and to helping women in medicine. She shares her vast knowledge of gender inequality in medicine, the wage gap in medicine, and what we can do to start making positive changes today. Dr. Jain is a board-certified hematology and oncology physician. She's a tenured associate professor of medicine in the division of Hematology and Oncology at the University of Illinois in Chicago. She's the director of communication strategies in medicine and the associate director of oncology communication and digital innovation at the University of Illinois Cancer Center. She is the founder and president of the 501(c)(3) nonprofit Women in Medicine, and the founder and chair of the Women in Medicine Summit. She's the CEO and co-founder of the action, advocacy, and amplification organization IMPACT.
In This Show:
Creating the Women in Medicine Summit
Today, we're going to be diving into being women in medicine. You are the founder of the Women in Medicine Summit, and I've been so fortunate to be invited to speak there the last couple of years. It's really a transformative experience for women to talk about our struggles and our experiences and to learn from each other. Can you tell us a little bit about you and what brought you to start this amazing organization?
“Yes, thank you so much. It's been a long road, I will say. We've grown quite a bit since our first year. I started the Women in Medicine Summit because of my experience on maternity leave with my twins. I have three kids: 8, 5, and 5 now. I went on maternity leave, and I was doing more on Twitter because I had recently published some op-eds. My institution had said, you need to get more engaged on social media. I started to read what other women in medicine were sharing about things that had happened to them. I realized that a lot of things that had happened to me throughout my training and my career were not because I wasn't a good physician, not because I didn't deserve a certain award or accolade or opportunity. But in actuality, it was because there were a lot of barriers in the healthcare system that were intrinsic to the way the system was set up.
Because I had never talked to anyone about it, because I'd never told anyone about my struggles, I just thought that I was the problem and I thought that I had not done something right and that had resulted in whatever the outcomes were. I came back from maternity leave with this newfound desire to create an opportunity for women to come together and really talk about these challenges. But more than that, my dad is a surgeon and has told me, “You don't just come with problems, you come with solutions.” For me, it was the opportunity to create a conference that was really about talking about the problems but then also really focusing on solutions. Providing professional development, providing ways to fix the system, providing ways to get male allies involved and engaged. These were all things that were really important to me, because I felt like if I'd had something like that earlier in my career, I may have had a different experience going through training and then as a junior faculty.
I created the summit, and the first year it was really successful. I was fortunate in that the year before I'd actually created Women in Medicine programming at Northwestern, where I had been on faculty at the time. I used my knowledge from that event to expand and grow this Women in Medicine summit. Since then, it's become this amazing conference where what I've been told—I can say this objectively, even though subjectively I think it's amazing since I made it—is that it's been life changing for them. It's been transformative, as you mentioned, because not only do you get the leadership training, not only do you get the negotiation skills, the financial skills from you when you speak there, and the CME, you also create these networks and communities across the country and now across the globe that have actually resulted in many of the people who attend getting opportunities for media appearances, getting opportunities for collaboration and research, getting mentorship and sponsorship opportunities.
The connections that have been forged at the last couple of summits have really resulted in the advancement of countless women in medicine. My hope is that as we continue to grow, we continue to see not only women, but also men who are taking up the torch and figuring out ways to fix the system within their own institutions and nationally. Actually, the first person who registered for the 2023 summit was a man. A lot of male allies are attending now because we created programming dedicated to allyship, as well, and helping men understand how they can be more inclusive leaders and how they can really work toward creating environments and creating structures and systems that allow for more diversity and more leadership at the top that is not just the same homogenous group of people we've seen for the last 100 years.”
Getting into Medicine and Activism
That's amazing. Tell us a little bit more about what brought you to medicine and what your experience was in medicine that really prompted you to start this huge movement.
“I knew that I wanted to be a doctor since I was a little kid. There were times in college where I dabbled with other ideas, but I really thought that I wanted to be a doctor from the time I was little and I would shadow my dad. I would be 6, 7 years old and it'd be a Sunday, and I'd have nothing to do so my dad would take me to the hospital to round on his post-op patients. Seeing that relationship that my dad had with his patients, either in the community or in the hospital, to me that was such a special relationship and I really loved the science. The more I learned about medicine, I really was just enthralled by being able to take care of people, help people navigate sometimes the most difficult parts of their lives and then develop these long-lasting relationships with patients and their families. That's how I decided to go into medicine.
The challenge was as I went through my training and as I became faculty, I started to notice that I was being treated a little bit differently than some of my colleagues. I initially thought, again, it must be me because the way I was raised was you work hard and you will succeed. If you realize you have deficiencies, you work on them, you improve on them, and then you will continue to grow.
Unfortunately, what I saw happening to myself and my colleagues would be two people would be exactly the same, let's say on their CV or in their accomplishments or how they presented on rounds. I kept noticing the men were getting offered the leadership positions. The men were getting offered opportunities for networking or they were getting offered opportunities to collaborate on research. I actually had people tell me that the work I was doing was a waste of time. I had people tell me that the work I was doing was not going to contribute to the national dialogue. When I found out I was pregnant, I had people tell me that I was failing the medical field because I was taking time off for maternity leave. I did not even take as much time as you really should take after you've had a C-section.
I was back as quickly as possible because I didn't want to impact my training. When I found out I was pregnant with twins, I had people telling me, ‘Oh, I was going to put you up for this opportunity, but now I'm not going to because you're having twins. So I can't imagine you'd want to.' When I interviewed for a position, I had a person actually tell me to my face that I would never be able to go full-time because he assumed I wanted more children. There was no reason for me to go full-time and he would take on any extra patients that came on. These are just the more benign comments. I had people sexually harass me. I had people basically threaten me. I honestly brushed all of these things off because I really assumed that I had done something wrong. It wasn't until I started speaking to other women that I realized that my experience was not unique to me.
My husband, who was my boyfriend at the time, used to ask me, ‘Why does this stuff keep happening to you?' Initially I thought, ‘Yeah, that's a good question. Why does this stuff keep happening to me? It's not happening to him.' Then, when I started talking to other women, I said, ‘Hey honey, why don't you talk to some of the other women that you work with and just mention, don't say it's me, just mention the experiences that I've had and see what they say.' If they say, ‘Wow, that's really strange,' then you're right, this is something that's just happening to me. He came back to me and he said, ‘Oh my gosh, this is happening to so many people.' I said, ‘I know.' And he said, ‘Why do I not know about it?' I said, ‘Well, one, you're a man, so it hasn't happened to you so you don't see it. And two, I said, there's a stigma about talking about these things.' I don't talk about this to anyone because if I talk about it to someone, they're going to think that I am less than or that I am to blame because that's what's happened to my other female colleagues who brought these things up.
For me, the reason that I really ended up in this position doing this work, which if you'd asked me 10 years ago, there's no way, not a chance I would've thought I'd be doing this particular work in healthcare. But it became so pervasive and so egregious in some of these situations that I knew being the person that I am, when I see a problem, I want to fix it. I couldn't imagine continuing on in healthcare without trying to do something to fix these problems.”
Your message really hits a note with so many because like you said, it is a pervasive problem and a lot of us don't want to bring it up. We're the type of people that are willing and able to pull ourselves up through our efforts. We certainly don't want to admit that there's anything else going on that could be hindering us. Thank you so much for bringing that to light.
More information here:
How to Prepare for Maternity and How It Could Affect Your Family’s Finances
The Gender Wage Gap in Medicine
We are a financial podcast, so we should talk about the money side of things, too. There's a lot of talk about a gender wage gap. It's been talked about throughout society and definitely in medicine. Is it real, Shikha? Do you think that's a real thing?
“One hundred percent. It's real. It's not even an opinion. I speak on this all the time, and oftentimes, I get the one person who says, ‘Well, in my practice, everyone gets paid the same.' And I say, ‘That's great. Your anecdotal evidence and anecdotal experience is really no match for the amount of mountains and mountains of data, objective data, we have that proves the pay gap is not only real, it's quite bad.' Dr. Vinny Arora published a paper just a few years ago showing for female physicians, over a projected 40-year career, can lose up to $2 million in their career. All of these studies that we talk about, these studies take into account maternity leave, family leave, part-time vs. full-time, RVU generation. They've taken into account all of these things and they still without fail have shown a persistent wage gap, which we see in society, as you mentioned. For women with intersectional identities, for women of color, the wage gap is even more profound. It's not a question of is there a wage gap, it's a question of how do we fix this wage gap that we 100% know exists?”
What are some factors that might explain this wage gap?
“There's a lot of things that factor into it. No. 1, I want everyone to remember that when the healthcare system was created, women were not in the healthcare workforce. When you look at the way that we compensate people, the work that is usually dedicated or allocated to women is not compensated. Women are often allocated to what Dr. Julie Silver refers to as citizenship tasks. Getting put on committees, organizing potlucks, working on DEI initiatives, working on mental health, working on wellness. A lot of those things are relegated into the female category often, and that work is often uncompensated and people do it in their free time because they know it's important.
McKinsey and LeanIn came out with a report a couple years ago that showed that, during the pandemic, the majority of the invisible work that was done was done by women. When we talk about invisible work, again, we talk about things like making sure your employees are happy and healthy, making sure mental health is taken care of, making sure that diversity and equity are at the forefront. Many institutions and organizations get awards for these things. They get more money for these things. They get accolades because they're doing so well, but that work is not compensated. Not only is it not compensated, it's not even really recognized or awarded. In the survey that McKinsey put out, the majority of the women surveyed said they never felt like they had been told that they were doing a good job. Many of them were considering leaving the workforce altogether. Dr. Amy Gottlieb with the AAMC made a comment, when the AAMC report came out talking about the wage gap. She said the problem is the way healthcare compensates people. It devalues the contributions of women. We really need to think about how we compensate people and we need to readjust what we are compensating for.
The second really big issue is the amount of time women spend with patients and the amount of time women spend on the EMR responding to patients. The data shows that women get more messages from their patients, and women spend more time responding and doing that work and spending time in the electronic medical record. Not because they aren't tech savvy, not because they don't understand how to use it, but because they simply just have more work to do. It's been hypothesized that because patients often feel that women are better communicators, they feel more comfortable talking to them. They feel more comfortable just messaging them as if it's an email. That time, again, it's not compensated and it's not valued. All of this has resulted in studies coming out that shows that the outcomes of the patients that are being treated by female physicians are actually better in some situations than the male colleagues.
There was a study that showed women physicians had lower readmission rates. Women physicians had lower mortality and morbidity with their patients. Women surgeons who operated on women patients actually had fewer complications and less mortalities. All of this just goes to show that women are working extremely hard and they're providing exceptional care, but the work they're doing is not compensated at the same level as the work that their male colleagues are doing.”
More information here:
Women and Money: Myths That Hold Us Back
What Can We Do on an Individual Basis to Improve the Wage Gap?
It does seem so insurmountable. What can women do to overcome it on an individual basis? What can we do as women in medicine to get better contracts, to get better compensation?
“There's a lot that we can do. From an individual standpoint, I think it's really important to have people in your corner. You need to have sponsors. You need to have stakeholders who care about you staying at the institution who can help you negotiate. They may be able to help you by telling you what other people's salaries are. They may be able to help you by telling you what you should be asking for. I actually have emailed people before negotiating for a new contract and said, ‘What all should I be asking for? I have no idea what I should ask.' Men do this all the time. I've had men reach out to me, men reach out to each other. Finding people to ask the questions of ,“What should I be asking for?” and, “What should I be getting paid?”
You should be looking at the national data and looking what the median and average is of somebody in your position, in your location. There's MGMA data that you can access that can help you with that information. At the end of the day, this isn't a man vs. woman thing. I'm talking about gender in the binary because that's how most of the studies have been done. But this isn't a men vs. women situation. This is really trying to find the right allies and stakeholders who are going to help you negotiate for yourself and make sure you don't undervalue yourself or undersell yourself. Women often don't like asking. It's uncomfortable. Even I feel uncomfortable when I ask my boss, ‘I want more protected time for this. I'm doing this much work. I feel like I should be compensated for this.' We have been taught not to talk about money. We've been taught that it's not polite to talk about your salary or your money. That is how we've ended up in this situation that we're in today.
I think from a leadership standpoint, we really need to be focusing on transparency, which can be very difficult. I know a lot of institutions have hired an outside consulting firm to do a kind of analysis and an audit of what their pay looks like, but then that data's often not given to the employees or the people who work in the hospital or the institution. Transparency is really key, and we need to be advocating for ourselves and for others. When I have my fellows who are negotiating for new contracts, I will tell them what they should be asking for. I tell them to figure out what their non-negotiables are. There are some things that are absolutely must-haves, like I must have X number of weeks of vacation. I must have X amount of CME funding. I must have X amount of a bonus or of a salary that I'm starting with.
There are some things that are going to be non-negotiable, and then there's some things that you need to think about, ‘Well, is this something that we could negotiate on?' I always say ask for more than what you actually want. Because if you shoot for the stars and you fall around the clouds, that's better than falling down on the ground. Find out what you really need and think ahead of time what is your floor and what is your ceiling?”
What Are Allies and Sponsors?
You mentioned finding allies and sponsors. Can you elaborate on that for me?
“It's really important to find allies and sponsors. It doesn't just have to be people in leadership. It can also be allies and sponsors who are at your same level. I often talk to a person who's recently negotiated a contract at the same institution, and I'll say, ‘What did you ask for? Do you have any ideas on what I should or shouldn't ask for?' It does help having allies in leadership. At the end of the day, everyone who you work for is going to want you to be successful. The way I always frame it is, I want to exceed your expectations in this position. I want to be the best employee, the best physician, the best whatever it is that you are hiring. In order to meet and exceed your expectations, these are the things that I need.
When you find those allies, they can sometimes help you and say, ‘These things are not going to happen, but these things are negotiable.' Sometimes what I do is talk to one of those allies ahead of time and I say, ‘This is what I'm going in with, do you think this is good? How should I present this?' At the end of the day, you need to present it in a way where the person you're talking to is going to respond positively. You don't want to leave with a negative feeling in your stomach or in their stomach. Pitching your ideas to one of those allies that you found ahead of time can be really helpful.
Again, you can do it to people at your own level, and you can also do it at somebody who's more senior than you who might have more experience. It doesn't have to be somebody at your institution. Most of the people who I've gone to have been people at other institutions. Then what you can say, well, I know at University X or at hospital system X, this is what they offer to their employees. This is what I would like to ask because I know this is what's being offered down the street. Sometimes, it can be really helpful to even have those allies outside of your own institution.”
And how do you go about finding these allies and sponsors?
“That is a tough one because it depends on where you are in your career. If you're a trainee, talk to the people within your organization. Talk to somebody who you've been doing research with or mentorship with. Find somebody who is doing what you want to do and ask them. Social media is a great way to find people like that. I found a lot of amazing allies, sponsors, mentors, and just listening ears through Twitter. What I've done sometimes is I'll tweet out I'm looking for someone who knows about X and people will reach out.
Sometimes what I do is I will find somebody who's doing exactly what I want to do and I will message them and say, ‘Hey, I'm looking for a position. I'm negotiating. Do you have a few minutes to talk? I'd love to hear about your position and how you negotiated for what you got.' I've had people reach out to me. I think I am one of the first, if not the first, director of communication for a cancer center in the country. It's not a really known position. I created it and I've had people reach out to me and say they are meeting with their leadership and they want to have a position similar to mine. They want to know what I asked for and how I got it paid for and what things I put on the job description. Find someone who's doing what you want to do, whether it's at your institution or not. Email them, or send them a message through social media. You can ask if one of your mentors knows them and can connect you. There's lots of ways to do that. Sometimes, you just have to step outside of your comfort zone.”
I've really found that people are so helpful and willing to offer information if you just reach out and ask. Thank you so much for doing that for other people, and I highly encourage other women to do the same.
The Effect of the Pandemic for Women in Medicine
Going back, you mentioned the COVID pandemic and how it has affected the wage gap. How has the COVID pandemic affected women in medicine? I happen to know you recently wrote a paper about it.
“I did recently write a paper about it. What we've seen with the pandemic is women are working more at home. They're increasing their home/work responsibilities. How many of us, if we have children, had to do virtual learning with our children while also trying to manage our full-time jobs? Women are doing more work at home in general. That's kind of societally how the system has been set up. We're seeing more men take on more of that work now, but we saw that gap widen during the pandemic. Things like arranging vaccine appointments, getting doctor's appointments, typically falls to women. Women who were working typically had a pretty good system in place for those things before the pandemic. That system kind of crumbled with childcare and schools being closed and not being able to have nannies or babysitters in the house. That was a huge challenge.
We're seeing women publish less. Again, it's not because women aren't ambitious and women aren't interested, it's because there's a finite number of hours in the day. When you get 6,000 other things piled on your shoulders, it's sometimes hard to prioritize things like academic publications. Not only that, but women weren't getting offered those opportunities for the same reason that I mentioned earlier. People think, ‘Oh, they're too busy doing home things, so I'm not even going to offer them the opportunity.' We also saw women just having less time for everything that's been documented, and we documented that we saw a significant change in the amount of time that women had to do things like Zoom virtual happy hours or socializing after work and things like that.
We also saw a widening of the pay gap. I don't know if you remember near the beginning of the pandemic, there were freezes put on for bonuses and there were freezes put on for promotions because everything was focused on the pandemic response. The thought was that these would be temporary. But unfortunately, even a short amount of time where you have your bonuses frozen or you have your ability to ascend and get a higher amount of salary to be frozen for a short amount of time, that can actually have long-term impacts on your overall ability to make X amount of dollars over a career. The temporary changes that we saw at the beginning of the pandemic and the temporary stop gaps that were put in place, we are starting to see now how they're really impacting women in medicine and how they're going to continue to impact them probably for years to come.”
More information here:
You Should Invest Like a 50-Year-Old Woman
Fixing the System Is Good for Everyone
We've really covered a lot of great topics here. Thank you, Dr. Jain. Do you have any parting thoughts for our listeners? Any way to lift them up and help them get over this wage gap, get over COVID’s impact on us?
“I am always a solutions-type person and I am typically pretty positive, although a lot of the stuff I talk about seems very depressing and sad because it's 2023 and we still have all of these pervasive inequities. My biggest challenge to everyone out there is thinking really hard about why do these systems still exist the way they do and who are they really serving? Because at the end of the day, we have a healthcare crisis for everyone. It's not just women. The pandemic has really laid bare the deficiencies in our healthcare system, and it's resulted in what they call a great resignation where we see so many physicians, nurses, healthcare workers, men and women leaving the field. At the end of the day, when we advocate for people to be treated equitably, when we advocate for men and women and people of all colors and all genders to be paid equally, to be treated equally, to be advanced equitably, we really end up with a trickle-down effect where the patients benefit, a trickle-down effect where the institutions benefit.
Studies have shown that institutions with more diversity at the top actually have higher retention rates. They get more awards, they get more accolades, they get more money. All of these things, regardless of whether you think it's the right thing to do or not, they have positive impacts at all levels. It's really past time for us to shine a light on this and for us to fix it. People have been talking about this for decades, and there are so many people who have worked so hard to try to move things forward. We're at a watershed moment where we have an opportunity to really fix the system and repair and replace a lot of these structures that have been in place for years that are very antiquated.
I encourage you to think critically about what you as an individual can do to start working toward fixing some of these challenges we talked about. Think outside of your normal circle, offer opportunities to people you wouldn't normally think of. If you're in leadership, it's time to start thinking really critically about what am I doing at my institution to make sure that we are really focusing on providing an equitable environment for the people who work here and for our patients. Because at the end of the day, it's not about DEI or diversity, equity and inclusion. It's not about that buzzword. It's really about figuring out how to provide the best care to our patients. The data consistently shows that in order to do that, we need to make sure we're also treating our healthcare workers equitably.
I encourage everyone to come to the Women in Medicine Summit. It's September 22-23 in Chicago, open to people of all genders and at all stages in their careers. Whether you're retired or in the C-suite or just starting out and a first-year attending, there's a lot of opportunities for growth and leadership development for people of all genders. We have a lot of other programming through our Women in Medicine nonprofit as well. Whether it's through our organization or through other organizations, I would recommend you look for those resources because a lot of them exist and they can really help you transform your organization, They can help you transform your own personal and professional life to lead a life where you're actually happy in your job, where you're actually wanting to go to work, where you actually feel excited and you remember why you went into medicine in the first place. It's possible to retain that joy for your entire career. We just need to be thinking how do we really protect and take care of our healthcare workers to make sure our healthcare system doesn't completely implode as we continue to navigate the long-term outcomes of this pandemic.”
Thank you. Dr. Jain. Where can our listeners find you if they have more questions?
“I'm pretty easy to find. I'm on Twitter and Instagram and LinkedIn and Facebook. I'm at Shikha Jain, MD on most of those platforms. On LinkedIn, I think I'm Shikha Jain, MD, FACP. You can also find me on the Women in Medicine social media handles at WIM Summit on Twitter, LinkedIn, Facebook, and Instagram as well. I have a website shikhajainmd.com, and you can find all my contact info there as well. I'd be happy to hear from anyone who's interested in getting involved or just talking more about any of these topics.”
Thank you so much, Dr. Jain, for coming and sharing your wisdom with us and for sharing your time with us today. It's been a really wonderful conversation.
What an insightful conversation with Dr. Jain. Whether we're men or women, we all suffer if a colleague is suffering. We all suffer if we lose someone in our practice. It pays for everyone if we close the gender wage gap and work on the factors that created it in the first place. What I really loved about this conversation is that not only did we identify the problem, Dr. Jain also offered several solutions. And those solutions were largely centered around helping each other. I hope you'll become one of the people that will reach down and help the next person after you.
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Full Transcript
Intro:
This is the White Coat Investor podcast where we help those who wear the white coat get a fair shake on Wall Street. We've been helping doctors and other high-income professionals stop doing dumb things with their money since 2011.
Dr. Disha Spath:
Hello and welcome to another White Coat Investor podcast. I'm your host, Dr. Disha Spath.
Dr. Disha Spath:
Today's episode is sponsored by locumstory.com. Everyone has a story, different needs, wants, and goals, and how to attain them. Your story determines your solution. Whatever your situation and story, locum tenens should be part of that conversation.
Dr. Disha Spath:
How do you find out if locums is a good option for you? Go to an unbiased, informative source like locumstory.com. You'll learn all the ins and outs of locums, details on travel and housing, assignment coordination, tax information, and more.
Dr. Disha Spath:
You'll also hear first-hand stories from locums physicians from all walks of life, so you get a bigger picture of the diverse options. Get a comprehensive view of locums and decide if it's right for you at locumstory.com.
Dr. Disha Spath:
Today's quote of the day is by Dave Ramsey. “Financial peace isn't the acquisition of stuff. It's learning to live on less than you make so that you can give money back and have money to invest. You can't win until you do this.”
Dr. Disha Spath:
Well, it doesn't matter how much leverage or creative financing you use, you really cannot get around the fact that math is math. If you spend all the money that you make in the end, if you want to build wealth, it's not going to happen. You need to live on less than you make because wealth is what you keep, it's not what you earn. So I fully a 100% agree with this.
Dr. Disha Spath:
Don't forget about our women's happy hours. We do them once every month as sponsored by the White Coat Investor. This is a completely free and open invitation to women or anyone who identifies as female to come join us and just talk about money.
Dr. Disha Spath:
We all know it's a little hard to just talk about our financial situation in real life, in other situations that wouldn't really open us up to talk about our stocks and investing and our debt and all that.
Dr. Disha Spath:
So this hour is for you to come and talk to other people about money. This is how we all get ahead by being more open, by learning from each other in a safe and non-public space.
Dr. Disha Spath:
I hope you'll come and join us. We do them every month, and the information is available at whitecoatinvestor.com/happyhour. There you can enter your email and see the next few happy hours coming up. And once you're in the email chain, you'll get an email about every happy hour coming up next. So, make sure you do that. Make sure you get plugged in and come join us. We're having one tonight and another one next month when this episode goes live.
Dr. Disha Spath:
We are really lucky to have Dr. Shikha Jain here on the White Coat Investor podcast. Dr. Shikha Jain is a board certified hematology and oncology physician. She's a tenured associate professor of medicine in the division of Hematology and Oncology at the University of Illinois in Chicago. She's the Director of Communication Strategies in Medicine and the Associate Director of Oncology Communication and Digital Innovation at the University of Illinois Cancer Center.
Dr. Disha Spath:
Dr. Jain is the founder and president of the 501(c)(3) nonprofit Women in Medicine, and the founder and chair of the Women in Medicine Summit. She's the CEO and Co-Founder of the action, advocacy and amplification organization IMPACT.
Dr. Disha Spath:
Dr. Jain was named one of Medscape’s 25 Rising Stars in Medicine in 2020. One of Modern Healthcare's Top 25 Emerging Leaders in 2019, and also awarded the Rising Star Award by the Lead Oncology Conference in 2019.
Dr. Disha Spath:
She's a nationally renowned keynote speaker and has written for several national publications including USA Today, CNN, Good Morning America, Scientific American, The Hill, US News, Newsweek, and has been interviewed in the New York Times and Washington Post. She is a regular TV contributor on FOX 32 and has been a guest on ABC7, CBS, WGN, and other national media outlets. Welcome Dr. Jain.
Dr. Shikha Jain:
Thanks so much for having me. This is going to be really fun. I'm excited for this conversation.
Dr. Disha Spath:
Whew. I'm out of breath reading your introduction. That is quite impressive. I saw you on TV this morning.
Dr. Shikha Jain:
I think I need to start sending a shorter bio.
Dr. Disha Spath:
Oh, no. Actually this was the short version of your bio. The longer version was even more impressive. But thank you so much for being here.
Dr. Disha Spath:
Today we're going to be diving into being women in medicine. As I said earlier, you are the founder of the Women in Medicine Summit, and I've been so fortunate to be invited to speak there at the last couple of years. It's really a transformative experience for women to talk about our struggles, our experience, and to commiserate and learn from each other.
Dr. Disha Spath:
Can you tell us a little bit about you and what brought you to start this amazing organization?
Dr. Shikha Jain:
Yeah, thank you so much. It's been a long road, I will say. We've grown quite a bit since our first year. I started the Women in Medicine Summit because I actually had been on maternity leave with my twins. I have three kids, eight, five and five now. And I went on maternity leave and I was doing more on Twitter because I had recently published some op-eds. My institution had said, you need to get more engaged on social media.
Dr. Shikha Jain:
I started to read what other women in medicine were sharing about things that had happened to them. And I realized that a lot of things that had happened to me throughout my training and my career were not because I wasn't a good physician, not because I didn't deserve a certain award or accolade or opportunity, but in actuality it was because there were a lot of barriers in the healthcare system that were intrinsic to the way the system was set up.
Dr. Shikha Jain:
And because I had never talked to anyone about it, because I'd never told anyone about my struggles, I just thought that I was the problem and I thought that I had really not done something right and that had resulted in whatever the outcomes were.
Dr. Shikha Jain:
And so, I came back from maternity leave with this newfound desire to create an opportunity for women to come together and really talk about these challenges. But more than that, because my dad is a surgeon and has told me, “You don't just come with problems, you come with solutions.”
Dr. Shikha Jain:
For me, the opportunity to create a conference that was really about talking about the problems, but then really focusing on solutions. Providing professional development, providing ways to fix the system, providing ways to get allies. So, male allies involved and engaged.
Dr. Shikha Jain:
These were all things that were really important to me because I felt like if I'd had something like that earlier in my career, I may have had a different experience going through training and then as a junior faculty.
Dr. Shikha Jain:
And so, I created the summit and the first year it was really successful. I was fortunate in that the year before I'd actually created Women in Medicine programming at Northwestern, where I had been on faculty at the time. And I used my knowledge from that event to expand and grow this Women in Medicine summit.
Dr. Shikha Jain:
And since then it's become this amazing conference where what I've been told, I can say this objectively, even though subjectively I think it's amazing since I made it, but objectively people have told me that it's been life changing for them.
Dr. Shikha Jain:
It's been transformative as you mentioned, because not only do you get the leadership training, not only do you get the negotiation skills, the financial skills from you when you speak there, and the CME, you also create these networks and communities across the country and now across the globe that have actually resulted in many of the people who attend getting opportunities for media appearances, getting opportunities for collaboration and research, getting mentorship and sponsorship opportunities.
Dr. Shikha Jain:
The connections that have been forged at the last couple of summits have really resulted in the advancement of countless women in medicine. And my hope is that as we continue to grow, we continue to see not only women, but also men who are taking up the torch and figuring out ways to fix the system within their own institutions and nationally.
Dr. Shikha Jain:
Actually the first person who registered for the 2023 summit was a man.
Dr. Disha Spath:
Wow.
Dr. Shikha Jain:
A lot of male allies are attending now because we created programming dedicated to allyship as well, and helping men understand how they can be more inclusive leaders and how they can really work towards creating environments and creating structures and systems that allow for more diversity and more leadership at the top that is not just the same homogenous group of people we've seen for the last hundred years.
Dr. Disha Spath:
That's amazing. Tell us a little bit more about what brought you to medicine and what your experience was in medicine that really prompted you to start this huge movement.
Dr. Shikha Jain:
I knew that I wanted to be a doctor since I was a little kid. There were times in college where I dabbled with other ideas, but I really thought that I wanted to be a doctor from the time I was little and I would shadow my dad. I would be six, seven years old and it'd be a Sunday and I'd have nothing to do. So, my dad would take me to the hospital to round on his post-op patients.
Dr. Shikha Jain:
And seeing that relationship that my dad had with his patients, either in the community or in the hospital, to me that was such a special relationship and I really loved the science. The more I learned about medicine, I really was just enthralled by being able to take care of people, help people navigate sometimes the most difficult parts of their lives and then develop these long-lasting relationships with patients and their families. That's how I decided to go into medicine.
Dr. Shikha Jain:
The challenge was as I went through my training and as I became faculty, I started to notice that I was being treated a little bit differently than some of my colleagues. And I initially thought, again, it must be me because the way I was raised was you work hard, you will succeed. If you realize you have deficiencies, you work on them, you improve on them, and then you will continue to grow.
Dr. Shikha Jain:
Unfortunately, what I saw happening to myself and my colleagues would be two people would be exactly the same, let's say on their CV or in their accomplishments or how they presented on rounds. And somehow I kept noticing the men were getting offered the leadership positions. The men were getting offered opportunities for networking or they were getting offered opportunities to collaborate on research.
Dr. Shikha Jain:
I actually had people tell me that the work I was doing was a waste of time. I had people tell me that the work I was doing was not going to contribute to the national dialogue. When I found out I was pregnant, I had people tell me that I was failing the medical field because I was taking time off for maternity leave, which I did not take as much time as you really should take after you've had a C-section.
Dr. Shikha Jain:
I was back as quickly as possible because I didn't want to impact my training. When I found out I was pregnant with twins, I had people telling me, “Oh, I was going to put you up for this opportunity, but now I'm not going to because you're having twins. So I can't imagine you'd want to.”
Dr. Shikha Jain:
When I interviewed for a position, I had a person actually tell me to my face that I would never be able to go full-time because he assumed I wanted more children. And so, there was no reason for me to go full-time. So he would take on any extra patients that came on.
Dr. Shikha Jain:
And these are just the more benign comments. I had people sexually harass me. I had people basically threaten me. And I honestly brushed all of these things off because I really assumed that I had done something wrong. And it wasn't until I started speaking to other women that I realized that my experience was not unique to me.
Dr. Shikha Jain:
My husband, who was my boyfriend at the time, used to ask me, “Why does this stuff keep happening to you?” And initially I thought, “Yeah, that's a good question. Why does this stuff keep happening to me? It's not happening to him.”
Dr. Shikha Jain:
And then when I started talking to other women, I said, “Hey honey, why don't you talk to some of the other women that you work with and just mention, don't say it's me, just mention the experiences that I've had and see what they say.” And if they say, “Wow, that's really strange”, then you're right, this is something that's just happening to me.
Dr. Shikha Jain:
And he came back to me and he said, “Oh my gosh, this is happening to so many people.” And I said, “I know.” And he said, “Why do I not know about it?” And I said, “Well, one, you're a man, so it hasn't happened to you so you don't see it. And two, I said, there's a stigma about talking about these things.” I don't talk about this to anyone because if I talk about it to someone, they're going to think that I am less than or that I am to blame because that's what's happened to my other female colleagues who brought these things up.
Dr. Shikha Jain:
And so for me, the reason that I really ended up in this position doing this work, which if you'd asked me 10 years ago, there's no way, not a chance I would've thought I'd be doing this particular work in healthcare. But it became so pervasive and so egregious in some of these situations that I knew being the person that I am, I see a problem, I want to fix it. I couldn't imagine continuing on in healthcare without trying to do something to fix these problems.
Dr. Disha Spath:
Yeah. Your message really hits a note with everyone because like you said, it is a pervasive problem and a lot of us don't want to bring it up because it makes us feel we don't want to be the victim. We're the type of people that are willing and able to pull us ourselves up through our efforts and with our bootstraps. And we certainly don't want to admit that there's anything else going on that could be hindering us. So thank you so much for bringing that to light.
Dr. Disha Spath:
We are a financial podcast, so we should talk about the money portion of it too. There's a lot of talk about a gender wage gap. It's been talked about throughout society and especially in medicine there seems to be reports of a wage gap. Is it real Shikha? Do you think that's a real thing?
Dr. Shikha Jain:
A hundred percent. It's real. It's not even an opinion. I speak on this all the time and oftentimes I get the one person who says, “Well, in my practice everyone gets paid the same.” And I say, that's great. Your anecdotal evidence and anecdotal experience is really no match for the amount of mountains and mountains of data, objective data we have that proves the pay gap is not only real, it's quite bad.
Dr. Shikha Jain:
We've actually shown Dr. Vinny Arora published a paper just a few years ago showing for female physicians over a projected 40 year career, they can lose up to $2 million in their career.
Dr. Disha Spath:
Wow.
Dr. Shikha Jain:
And all of these studies that we talk about, these studies take into account because the excuses I get are, “Oh, women get pregnant, women go part-time.” All of these studies have taken into account maternity leave, family leave, part-time versus full-time, RBU generation. They've taken into account all of these things and they still without fail have shown a persistent wage gap, which we see in society, as you mentioned.
Dr. Shikha Jain:
And for women with intersectional identities, for women of color, the wage gap is even more profound. And so, it's not a question of is there a wage gap? It's a question of how do we fix this wage gap that we 100% know exists?
Dr. Disha Spath:
What are some factors that might explain this wage gap?
Dr. Shikha Jain:
There's a lot of things that factor into it. Number one, I want everyone to remember that when the healthcare system was created, women were not in the healthcare workforce. And so, the way that we compensate our physicians, and not just physicians, nurses as well. There's a wage gap in the nursing field as well.
Dr. Shikha Jain:
When you look at the way that we compensate people, the work that is usually dedicated or allocated to women is not compensated. Women are often allocated to what Dr. Julie Silver refers to as citizenship tasks. So, getting put on committees, organizing potlucks, working on DEI initiatives, working on mental health, working on wellness. A lot of those things are really relegated into the female category often, and that work is often uncompensated and people do it in their free time because they know it's important.
Dr. Shikha Jain:
McKinsey and LeanIn came out with a report a couple years ago that showed during the pandemic, the majority of the invisible work that was done during the pandemic was done by women. And when we talk about invisible work, again, we talk about things like making sure your employees are happy and healthy, making sure mental health is taken care of, making sure that diversity and equity are at the forefront.
Dr. Shikha Jain:
And many institutions and organizations get awards for these things. They get more money for these things, they get accolades because they're doing so well, but that work is not compensated. And not only is it not compensated, it's not even really recognized or awarded.
Dr. Shikha Jain:
In the survey that McKinsey put out, the majority of the women surveyed said they never felt like they had been told that they were doing a good job. And many of them were considering leaving the workforce altogether.
Dr. Shikha Jain:
Dr. Amy Gottlieb with the AAMC, made a comment, when the AAMC report came out talking about the wage gap. And she said the problem is the way healthcare compensates people, it devalues the contributions of women. So, we really need to think about how we compensate people and we need to readjust what we are compensating for.
Dr. Shikha Jain:
The second really big issue that there was a paper that just came out recently on is the amount of time women spend with patients and the amount of time women spend on the EMR responding to patients.
Dr. Shikha Jain:
The data shows that women get more messages from their patients and women spend more time responding and doing that work and spending time in the electronic medical record. Not because they aren't tech savvy, not because they don't understand how to use it, but because they simply just have more work to do.
Dr. Shikha Jain:
And it's been hypothesized. It's because patients often feel that women are better communicators, they feel more comfortable talking to them. They feel more comfortable just messaging them as if it's an email. And so, that time, again, it's not compensated and it's not valued.
Dr. Shikha Jain:
And all of this has resulted in studies coming out that shows that the outcomes of the patients that are being treated by female physicians are actually better in some situations than the male colleagues.
Dr. Shikha Jain:
There was a study that showed women physicians had lower readmission rates. Women physicians had lower mortality and morbidity with their patients. Women's surgeons who operated on women patients actually had less complications and less mortalities.
Dr. Shikha Jain:
All of this just goes to show that women are working extremely hard and they're providing exceptional care, but the work they're doing is not compensated at the same level as the work that their male colleagues are doing.
Dr. Disha Spath:
It does seem so insurmountable. The amount of factors that go into this wage gap. What can women do to overcome it on an individual basis? What can we do as women in medicine to get better contracts, to get better compensation?
Dr. Shikha Jain:
There's a lot that we can do. From an individual standpoint, I think it's really important to have allies and people in your corner. You need to have sponsors. You need to have stakeholders who care about you staying at the institution who can help you negotiate. They may be able to help you by telling you what other people's salaries are. They may be able to help you by telling you what you should be asking for.
Dr. Shikha Jain:
I actually have emailed people before negotiating for a new contract and said, “What all should I be asking for? I have no idea what I should ask.” And men do it all the time. I've had men reach out to me, men reach out to each other. Finding people to ask really the questions of “What should I be asking for and what should I be getting paid?”
Dr. Shikha Jain:
You should be looking at the national data and looking what the median and average is of somebody in your position, in your location. There's MGMA data that you can access that can help you with that information.
Dr. Shikha Jain:
And at the end of the day this isn't a man versus woman thing. I'm talking about gender in the binary because that's how most of the studies have been done. But this isn't a men versus women's situation. This is really trying to find the right allies and stakeholders who are going to help you negotiate for yourself and make sure you don't undervalue yourself or undersell yourself. Because women often don't like asking. It's uncomfortable.
Dr. Shikha Jain:
Even I feel uncomfortable when I ask my boss, “I want more protected time for this. I'm doing this much work. I feel like I should be compensated for this.” It's always we've been taught not to talk about money. We've been taught that it's not polite to talk about your salary or your money. And that is how we've ended up in this situation that we're in today.
Dr. Shikha Jain:
I think from a leadership standpoint, we really need to be focusing on transparency, which can be very difficult. I know a lot of institutions have hired an outside consulting firm to do a kind of analysis and an audit of what their pay looks like, but then that data's often not given to the employees or the people who work in the hospital or the institution.
Dr. Shikha Jain:
Transparency is really key, and we need to be advocating for ourselves and for others. When I have my fellows who are negotiating for new contracts, I will tell them, okay, I know you're going for your first negotiation. Here are the things that you should ask for. Figure out what are your non-negotiables. There are some things that are absolutely must, like I must have X number of weeks of vacation. I must have X amount of CME of funding. I must have X amount of a bonus or of a salary that I'm starting with.
Dr. Shikha Jain:
There are some things that are going to be non-negotiable, and then there's some things that you need to think about “Well, is this something that we could negotiate on?” I always say ask for more than what you actually want. Because if you shoot for the stars and you fall around the clouds, that's better than falling down on the ground. So find out what you really need and think ahead of time what is your floor and what is your ceiling?
Dr. Disha Spath:
Okay, you mentioned finding allies and sponsors. Can you elaborate on that for me?
Dr. Shikha Jain:
Yeah. It's really important to find allies and sponsors. It doesn't just have to be people in leadership. It can also be allies and sponsors who are at your same level. I often talk to a person who's recently negotiated a contract at the same institution, and I'll say, “What did you ask for? Do you have any ideas on what I should or shouldn't ask for?” It does help having allies in leadership.
Dr. Shikha Jain:
And at the end of the day, everyone who you work for is going to want you to be successful. And so, the way I always frame it is, I want to exceed your expectations in this position. I want to be the best employee, the best physician, the best whatever it is that you are hiring. In order to meet and exceed your expectations, these are the things that I meet and that's kind of how I approach it.
Dr. Shikha Jain:
And when you find those allies, they can sometimes help you and say, “Well, these things are not going to happen, but these things are negotiable.” Sometimes what I do is I will talk to one of those allies ahead of time and I will say, “This is what I'm going in with, do you think this is good? How should I present this?”
Dr. Shikha Jain:
Because at the end of the day, you need to present it in a way where the person you're talking to is going to respond positively. You don't want to leave with a negative feeling in your stomach or in their stomach. And so, pitching it to one of those allies that you found ahead of time can be really helpful.
Dr. Shikha Jain:
And again, you can do it to people at your own level and you can also do it at somebody who's more senior than you who might have more experience. And it doesn't have to be somebody at your institution. Most of the people who I've gone to have been people at other institutions because then what you can say is, well, I know at University X or at hospital system X, this is what they offer to their employees. This is what I would like to ask because I know this is what's being offered down the street. So, sometimes it can be really helpful to even have those allies outside of your own institution.
Dr. Disha Spath:
And how do you go about finding these allies and sponsors?
Dr. Shikha Jain:
That is a tough one because it depends on where you are in your career. If you're a trainee, talk to the people within your organization. Talk to somebody who you've been doing research with or mentorship with. Find somebody who is doing what you want to do and ask them.
Dr. Shikha Jain:
Social media is a great way to find people like that. I found a lot of amazing allies, sponsors, mentors, and just listening ears through Twitter. And what I've done sometimes is I'll tweet out I'm looking for someone who knows about X and people will reach out.
Dr. Shikha Jain:
Sometimes what I do is I will find somebody who's doing exactly what I want to do and I will message them and say, Hey, I'm looking for a position. I'm negotiating. Do you have a few minutes to talk? I'd love to hear about your position and how you negotiated for what you got.
Dr. Shikha Jain:
I've had people reach out to me. I am I think one of the first, if not the first director of communication for a cancer center in the country. And it's not a really known position. I created it and I've had people reach out to me and say, I'm meeting with my leadership tomorrow and I want to have a position similar to yours. What did you ask for? How did you get it paid for? What are the things that you put in the job description?
Dr. Shikha Jain:
Find someone who's doing what you want to do, whether it's at your institution or not. And you can email them, you can send them message through social media. You can ask if one of your mentors knows them and can connect you. There's lots of ways to do that. Sometimes you just have to step outside of your comfort zone.
Dr. Disha Spath:
Yeah, I've really found that people are so helpful and willing to offer information if you just reach out and ask. Thank you so much for doing that for other people, and I highly encourage other women to do the same.
Dr. Disha Spath:
Going back, you mentioned the COVID pandemic and how it's sort of affected the wage gap. How has the COVID pandemic affected women in medicine? I happen to know you recently wrote a paper about it.
Dr. Shikha Jain:
I did recently write a paper about it. What we've seen with the pandemic is women are working more at home. And so, they're increasing their home/work responsibilities. How many of us if we have children, had to do virtual learning with our children while also trying to manage our full-time jobs?
Dr. Shikha Jain:
Women are doing more work at home in general. That's kind of societally how the system has been set up. We're seeing more men take on more of that work now, but we saw that gap widen during the pandemic and sick leave, taking care of elderly family members. That's another thing that women started having to do more at home.
Dr. Shikha Jain:
Arranging vaccine appointments, getting doctor's appointments, all of that stuff that before women typically who were working had a pretty good system in place. That system kind of crumbled with childcare and schools being closed and not being able to have nannies or babysitters in the house. That was a huge challenge.
Dr. Shikha Jain:
We're seeing women publish less. And again, it's not because women aren't ambitious and women aren't interested, it's because there's a finite number of hours in the day, and when you get 6,000 other things piled on your shoulders, it's sometimes hard to prioritize things like academic publications.
Dr. Shikha Jain:
And not only that, again, women weren't getting offered those opportunities for the same reason that I mentioned earlier. People think, “Oh, they're too busy doing home things, so I'm not even going to offer them the opportunity.”
Dr. Shikha Jain:
We also saw women just having less time for everything that's been documented and documented that we saw a significant change in the amount of time that women had to do things like Zoom virtual happy hours or socializing after work and things like that.
Dr. Shikha Jain:
We also saw a widening of the pay gap. And what happened was, I don't know if you remember near the beginning of the pandemic, there were freezes put on for bonuses and there were freezes put on for promotions because everything was kind of focused on the pandemic response.
Dr. Shikha Jain:
And the thought was that these would be temporary. But unfortunately, even a short amount of time where you have your bonuses frozen or you have your ability to ascend and get a higher amount of a salary to be frozen for a short amount of time, that can actually have long-term impacts on your overall ability to make X amount of dollars over a career.
Dr. Shikha Jain:
And so, the temporary changes that we saw at the beginning of the pandemic and the temporary kind of stop gaps that were put in place were starting to see now how they're really impacting women in medicine and how they're going to continue to impact them probably for years to come.
Dr. Disha Spath:
Absolutely. We've really covered a lot of great topics here. Thank you Dr. Jain. Do you have any parting thoughts for our listeners? Any way to lift them up and help them get over this wage gap, get over COVID’s impact on us?
Dr. Shikha Jain:
Well, I am always a solutions type person and I am typically pretty positive, although a lot of the stuff I talk about seems very depressing and sad because it's 2023 and we still have all of these pervasive inequities.
Dr. Shikha Jain:
My biggest challenge to everyone out there is thinking really hard about why do these systems still exist the way they do and who are they really serving? Because at the end of the day, we have a healthcare crisis for everyone. It's not just women. The pandemic has really laid bare the deficiencies in our healthcare system and it's resulted in what they call a great resignation where we see so many physicians, nurses, healthcare workers, men and women leaving the field.
Dr. Shikha Jain:
At the end of the day, when we advocate for people to be treated equitably, when we advocate for men and women and people of all colors and all genders to be paid equally, to be treated equally, to be advanced equitably, we really end up with a trickle-down effect where the patients benefit, a trickle-down effect where the institutions benefit.
Dr. Shikha Jain:
Studies have shown that institutions with more diversity at the top actually have higher retention rates, they get more awards, they get more accolades, they get more money. All of these things, regardless of whether you think it's the right thing to do or not, they have positive impacts at all levels. It's really past time for us to shine a light on this and for us to fix it. People have been talking about this for decades, and there are so many people who have worked so hard to try to move things forward.
Dr. Shikha Jain:
We're at a point now where we're at a watershed moment where we have an opportunity to really fix the system and repair and replace a lot of these structures that have been placed for years that are very antiquated.
Dr. Shikha Jain:
I encourage you to think critically about what you as an individual can do to start working towards fixing some of these challenges we talked about. Think outside of your normal circle, offer opportunities to people you wouldn't normally think of. And if you're in leadership, it's time to start thinking really critically about what am I doing at my institution to make sure that we are really focusing on providing an equitable environment for the people who work here and for our patients.
Dr. Shikha Jain:
Because at the end of the day, it's not about DEI or diversity, equity and inclusion, it's not about that buzzword. It's really about figuring out how to provide the best care to our patients. And the data consistently shows that in order to do that, we need to make sure we're also treating our healthcare workers equitably.
Dr. Shikha Jain:
And so, I encourage everyone to come to the Women in Medicine Summit. It's September 22nd and 23rd in Chicago, open to people of all genders and at all stages in their careers. Whether you're retired or in the C-suite or just starting out and a first year attending, there's a lot of opportunities for growth and leadership development for people of all genders. We have a lot of other programming through our Women in Medicine nonprofit as well.
Dr. Shikha Jain:
Whether it's through our organization and through other organizations, I would recommend you looking for those resources because a lot of them exist and they can really help you transform your organization and they can help you transform your own personal and professional life to lead a life where you're actually happy in your job, where you're actually wanting to go to work, where you actually feel excited and you remember why you went into medicine in the first place.
Dr. Shikha Jain:
It's possible to retain that joy for your entire career. We just need to be thinking how do we really protect and take care of our healthcare workers to make sure our healthcare system doesn't completely implode as we continue to navigate the long-term outcomes of this pandemic.
Dr. Disha Spath:
Thank you. Dr. Jain. Where can our listeners find you if they have more questions?
Dr. Shikha Jain:
Well, I'm pretty easy to find. I'm on Twitter and Instagram and LinkedIn and Facebook. I'm at Shikha Jain, MD on most of those platforms. On LinkedIn, I think I'm Shikha Jain, MD, FACP. You can also find me on the Women in Medicine social media handles at WIM Summit on Twitter, LinkedIn, Facebook, and Instagram as well.
Dr. Shikha Jain:
And I have a website shikhajainmd.com, where you can find ways to contact me there as well. And I'd be happy to hear from anyone who's interested in getting involved or just talking more about any of these topics.
Dr. Disha Spath:
Thank you so much Dr. Jain for coming and sharing your wisdom with us and for sharing your time with us today. It's been a really wonderful conversation.
Dr. Shikha Jain:
Thanks so much for having me.
Dr. Disha Spath:
Absolutely.
Dr. Disha Spath:
What an insightful conversation with Dr. Jain. Whether we're men or women, we all suffer if a colleague is suffering. We all suffer if we lose someone in our practice. We all suffer if they're unhappy and it pays for everyone if we close the gender wage gap and work on the factors that created it in the first place.
Dr. Disha Spath:
What I really loved about this conversation is that not only did we identify the problem, Dr. Jain also offered several solutions. And those solutions were largely centered around helping each other.
Dr. Disha Spath:
Finding allies and sponsors, reaching out to people that have the jobs that we want, and asking them, simply asking them for help, asking them for truthful information about what they're getting paid and how you can get the same and how you can advocate for yourself. And honestly, a lot of people are willing to help.
Dr. Disha Spath:
I hope you'll become one of the people that will reach down and help the next person after you to get their pay to keep them in medicine because we all need people to work with us, to be our colleagues and stay in medicine.
Dr. Disha Spath:
I hope we can learn something from this conversation with Dr. Jain and go forward and I hope you'll attend the Women in Medicine Summit. I'll be speaking there this year again about finances. It really is one of the most actionable conferences I found for women to help each other and get that allyship that's so critical to our success.
Dr. Disha Spath:
Don't forget, this podcast is sponsored by a locumstory. Everyone has a story, different needs, wants, and goals, and how to attain them. Your story determines your solution. Whatever your solution and story, locum tenens should be part of that conversation.
Dr. Disha Spath:
How do you find out if locums is a good option for you? Go to an unbiased, informative source like locumstory.com. You'll learn all the ins and outs of locums, details on travel and housing, assignment coordination, tax information, and more.
Dr. Disha Spath:
You'll also hear first-hand stories from locums physicians from all walks of life, so you get a bigger picture of the diverse options. Get a comprehensive view of locums and decide if it's right for you at locumstory.com. Speaking of sharing our experiences, Locumstory is a great place to do that as well.
Dr. Disha Spath:
All right. Don't forget about our women's happy hours. We're doing them every month. And you can sign up at whitecoatinvestor.com/happyhour. That's where you're going to find the place to enter your email so you are in the know about the next one coming up. And remember to bring your favorite cocktail or non-alcoholic beverage and come and just chit chat with us about whatever you want to talk about as related to finances.
Dr. Disha Spath:
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Dr. Disha Spath:
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“ All of these studies that we talk about, these studies take into account maternity leave, family leave, part-time vs. full-time, RVU generation.”
If it is an answer then does it mean that male providers simply work more?
On average, yes, male doctors work more. But I don’t think that’s what the interviewee is saying. I think she’s saying that she has seen lots of studies that are appropriately adjusted for working less or taking more time off or whatever and they still show a gender wage gap.
While I think she’s probably right that there is some sort of gender wage gap on average (obviously there are plenty of groups like mine where there is no real gap and plenty of people in solo practice where there is no gap) but it isn’t as large as many studies show because those studies simply aren’t controlled/adjusted for all of the things they should be. What I have not seen, however, is a lot of good studies that actually do control for those things in medicine. So I’d love to see the ones she’s looking at. The surveys I see often that claim a wage gap definitely are not controlled. I’m thinking like the annual Medscape survey like this one:
https://www.medscape.com/slideshow/2022-compensation-overview-6015043#7
That cites a 23-25% wage gap. But as I recall, all Medscape does is ask you how much you make and what your gender is. That’s not controlling for any of the stuff that needs to be controlled for including:
Hours worked
RVUs generated
Type of work done
Amount of call
Time taken off in a given year and prior years
Specialty
etc. etc.
Yet they report a “wage gap.” That’s not scientifically sound.
Personally, I’d be more concerned about this slide about race disparity:
https://www.medscape.com/slideshow/2022-compensation-overview-6015043#7
While they didn’t control for any of that stuff either, it seems much less likely that there is a significant difference in RVUs generated or hours worked due to the color of your skin. There may be a significant specialty difference though which may explain most of that particular gap.
This one is a much better study from the NEJM.
https://www.nejm.org/doi/full/10.1056/NEJMsa2013804
From the article:
I find that stuff really interesting. Women are practicing differently from men and possibly seeing different types of patients.
And of course there is plenty of anecdotal evidence out there of real discrimination too.
I wonder if any doctor here who can say they personally observed such problem.
I have personally seen active discrimination against White males. Straight Asian men are discriminated too.
At my employer (Kaiser) we are in salary bands by seniority. We don’t have RVUs. BIPoc LGBT+ get promoted to positions of prestige. Lol, in my department there are 0 white males aside from me. I’m going into private practice once my loans are paid off. There’s no future for people like me. Just being real, yo.
Resident here. All leadership positions in my program, except chair (for now) are female (program director, APD, outpatient director, inpatient director, all 5 chief residents, etc). I am pretty sure it’s a title ix violation against men in this program.
On the other hand, it’s academics and the pay here is abysmal. This is self imposed. I am counting the days to leave academics.
It’s very interesting to me that when leadership is mostly men or all men, the natural assumption from men is “they must be the best people for the job.”
But when leadership is mostly women, the frequent response from men is “it must be discrimination against men.”
When you flip a coin 15 times and its heads every single time, you better check to see both sides aren’t just heads.
They openly talk about how happy they are with it being all females selected. I know for a FACT a man with an outstanding CV was turned down for some positions. Their whole CV was tailored for the position. It’s almost as though women can discriminate too. The problem is when it now done as “payback.”
You’re better than this, Jim. Are there real issues faced by women in medicine? Of course, but you should know better than to accept this DEI, leftist propaganda without any pushback. Your site has started taking a leftward tilt over the past few months and it’s concerning.
Instead of accusing Jim of leftest propaganda, why not just read the articles he cited to justify his point, and provide a fact based counter in a civil way?
Thanks for the feedback. I guess I won’t make all the WCI employees join the communist party as I had planned.
WCI is using his platform to promote divorce, abortion, and now repeating the lie of the wage gap.
Women get preferential admissions and treatment in undergrad, med school, residency marching, and hiring.
Citing one p-value-hacking paper to defend something WE ALL KNOW ISN’T TRUE is just laziness. Do you honestly think someone would fund a study showing and the NEJM would publish a study showing no wage gap?
Can I still get reimbursed from WCI for my $60 annual Communist Party dues payment?
Well that’s just great. Now what am I going to do with all the “Welcome Comrade!” party hats I just bought?
Lol when the only supportive comments are from people who get paid by WCI.
That’s actually not true, keep reading. Would love to see the studies you’re basing your very confident assessment on, Will Smith. Care to share?
You get paid by WCI.
Like I said, it’s sad when a blog has to pay for positive comments.
Luckily the negative ones are all free.
No matter what you think about this particular post your comment about what WCI “promotes” is way off base and completely divorced from reality. I don’t get paid by WCI but I am offended on his behalf.
Let me know where to send your payment.
Kinda makes sense if you ask me. Dr. Dahle is a partner at his practice, thereby “seizing the means of production”, advocates that everyone own total stock market funds, thereby “collectivizing ownership of the economy”, runs multiple blogs and social media accounts where members “contribute what they can and take what they need”… He’s practically a communist already. 😉
I should write a manifesto.
I’ve never, ever heard of a medical practice that pays women less than men. This may be “anecdotal evidence”, but can you please give some specific examples of medical groups that pay women less than men?
As a woman, I’m tired of just being told to “trust the evidence” that this gender pay gap is true. I’ve worked hard my whole career, and have always been payed based on hours worked and productivity. I’ve never made less because I’m a woman.
There (may) be a few examples of a gender pay gay when you look at the whole country, but my bet is they are very few and far in between.
The classic example is an academic group at a University or other group of employees where after working there for 10 years a woman finds out that the guy in the clinic down the hall doing the same work (or perhaps even less) is getting paid more. Happens all the time. Whether she just didn’t negotiate as well or is being discriminated against, it’s pretty common.
But I think your experience is also very common. That’s basically the story in every job I’ve ever had. Military pay was exactly the same. Partner pay in my group is simply based on shifts worked. The night docs get paid more, but those shifts are just as available to women as men.
Women getting paid less than men is far more rampant thand we’d like to think. I’m an emergency medicine physician, my wife is also an EM physician.
She’s an academics, and every year has to negotiate her buy-down with her chair. It’s common fact that the men in her institution get paid significantly more than the women (or have more buy-down), simply becuase they are more comfortable leaving or switching jobs.
Personally, I work in the commuinty and before we were a large corportate group, we were a small democratic group . As a partner in a SDG, I regularly saw significant pay discrepancies with the female physicians we hired, and outright discrimination when making decisions about who would be the next partner. When I was chair of the ED, sign on bonuses ended up being higher for men because if the group offered X dollars, the man would come back saying “2X” where as my female hires would bec happy with X.
We can be better than this.
Few years ago I did an experiment to buy a new car. I was able to negotiate a price $1500 better than my wife. I guess we should call it a discrimination too.
I don’t think asking X bonus or 2X bonus is actual discrimination.
I dont think it’s overt descrimination either. I do think it’s a clear reason for an pay gap that is very real and has a variety of cultural reasons behind it.
The slippery slope of “I’m better at negotiating so should be paid better” can be attributed to all classes of people commonly descriminated against.
I would venture to say that your statement about negotiating for a car supports the statement that “women pay more for cars than men” – which could be because you negotiate better, or because the salesman is more likely to accept a mans lower price than a womans.
In my experience, I doubt that a sales person “like” you either you are a man or a woman. It’s capitalism
Now we have to counter “surveys” with “facts”. This is getting a bit ridiculous. We don’t see articles posted on how the claims of such “studies” are lies, so in fact, yes, these are all examples of political propaganda. Sorta like how we never see national broadcasts on police killing “white” people, though that happens manifold more times per year. I wonder why.
Honk Honk
Hmmm. Thanks for stopping by Suchy McBuchy.
Interesting. I’m with Kaiser and it’s hard to see how there would be a pay gap (other than preferences in FTE) since everyone is paid the same based on seniority and shifts rate are identical. I guess people need to be willing to say no to uncompensated work — maybe that’s harder in academia where you are trying to raise up the ranks, and they count this as unpaid work? Also maybe this effect is more pronounced in academia where there are more differences in pay with career progression.
I could see how a woman pcp could potentially attract more needy patients and that could be more time intensive for the same fte level, leading them to be more likely to drop their fte level? Maybe the pay difference effect is more specialty dependent? I’m interested in making more money as a hospitalist and don’t know any other ways other than working more or working at a less desirable place with a higher rate.
Hi Greg,
Thank you for your comment. Yes, discrimination can be hard to prove or quantify. Often the pay scales are the same on an hourly, rvu, or capitated basis is the same, but the way hours are allotted, shifts are assigned, patients are allocated, or promotions are given are biased. I have personally heard stories from women that felt like they were a disadvantaged because they would get the overnight shifts that produced less RVU’s than their male counterparts. Or she provided the majority of the care to a patient in the primary care setting but the patient consistently put down someone else as their PCP so she didn’t get credit for their capitated payment. And then when a female says no, she is often labeled as difficult or not a team player.
Disha
Any documented evidence of insurance companies paying less for the same procedures in the same location based upon the gender or race of the surgeon? If so, that would be the big scandal (and a juicy class action lawsuit).
Haven’t seen it yet. I agree it would be scandalous.
Here is an article describing some research that show some data and information you may find interesting.
https://www.brighamhealthonamission.org/2021/05/11/double-discrimination-call-to-end-pay-and-gender-disparities-in-gynecologic-surgery/
——–
The disparity in pay between gynecologic surgery and other surgical specialties has been well-established. In a recent commentary, faculty from Brigham and Women’s Hospital and Northwestern University describe the history of this issue and other influences that drive what they call “double discrimination” — lower pay in an area of surgery that has the largest proportion of female surgeons and one that serves primarily female patients.
The authors call for changes that would create equity in reimbursement rates for gynecologic surgery, raising them to the level of other similar surgical specialties. The commentary was published in April 2021 in Obstetrics & Gynecology (download paper here).
“From an anatomical standpoint, we shouldn’t reimburse at lower rates for women’s surgery than for men’s surgery,” said senior author Louise Perkins King, MD, JD, a surgeon in the Brigham’s Division of Minimally Invasive Gynecologic Surgery and a member of the Center for Bioethics at Harvard Medical School. Some of the reasons why this is the case are noted in the commentary.
The Basis for Differences in Reimbursement
The differences in fees are due in large part to the rates at which Medicare and Medicaid reimburse surgeons. In the article, the authors cited two papers — one from 1997 and one from 2017 — that described the differences in the relative value unit assigned to gynecologic procedures compared to urologic procedures. Urologic procedures were used as the comparison because they are most closely related to gynecologic surgeries. Additionally, because a higher proportion of urologic surgeries are performed on men, it allowed the researchers to look at the differences in relation to patients’ biological sex.
They also discussed the 2007 Supreme Court case in which a woman named Lilly Ledbetter sued her former employer, Goodyear Tire and Rubber Company, over gender-based pay discrimination. The late Justice Ruth Bader Ginsburg dissented to the ruling against Ms. Ledbetter’s case, noting the many harms of gender-based pay discrimination. Justice Ginsburg’s legacy compelled the authors to point out this discrimination in medicine and the potential harm for patients.
“The fact that gynecologic surgery doesn’t pay as much as other specialties means that most obstetrician-gynecologists primarily practice obstetrics, which also pays lower than many other subspecialties, but pays a little bit better [than gynecologic surgery],” Dr. King said. “For that reason, many gynecologic surgeons, especially those in private practice, operate infrequently. This, in turn, can lead to higher complication rates, as referenced in literature included in the commentary, because the surgeons don’t have as much experience.”
Not that I know of. But insurers usually do not pay doctors directly. If they do, the doctor is the practice owner and that’s not what we’re talking about here since a woman owning her practice has the power to pay herself fairly. We are talking about physicians in employed positions.
Discussions of women in medicine and pay always bring out multiple divergent opinions, including “that doesn’t happen”. As with most divisive issues, the reality is complex.
Women tend to choose lower-paying specialities, to take time off for family (both children and parents), and to work fewer hours. I have done all of these things, and I would do them again. Good studies should correct for all of this, and there are some that do.
I haven’t heard of women being paid less per RVU than men (although given the state of corporate healthcare, I wouldn’t be surprised to learn this happens – and yes, I do have an anti-healthcare-administration bias, who is with me?). I think the pay differential is in part an indictment of our reimbursement system which rewards procedures and volume rather than time with patients, and disadvantages women physicians who tend to see fewer patients for longer, as referenced above.
Regardless, I don’t hear “find a mentor and support each other!” as inflammatory.
MC, you just hit the nail directly on the head. Medicine payment structures are reactive. Yes, it’s far riskier to evacuate a subarachnoid hemorrhage, and those kinds of injuries are rarely during the normal 8A-5P. So those docs should be paid well for depth of knowledge, risk, and crappy hours. It’s also true that preventive medicine is just as important given the millions of Americans with more mundane problems like diabetes and hypertension which cost billions in aggregate. I wish I knew the answer of how to value our work correctly.
Good point, Dan. I don’t know how to value our work, either, and I don’t think any of the metrics that are put on our work (right now its RVUs, what comes next is anyone’s guess) capture our work either. A neurosurgeon working nights and weekends should definitely get paid more than I do, for the huge differences in training, skill, and risks involved, not to mention the hours. Within a given speciality, I wish we could capture the preventive care that is undervalued. (I’m off-topic here, I know)
Well said, Margaret. Any conversation about diversity or equality brings out divergent opinions of those who have seen discrimination and those who refuse to see it but need to hear it the most. All we can do is keep trying to start the conversation to make things better for those after us.
Disha
So I can describe a specific example of how a gender wage gap could occur, because it happened at my old place of employment. And even though I was in leadership and called it out with evidence, I got ignored.
When a person goes to a part time FTE, naturally their RVU production will drop. However, what my previous employer would do is also prorate the RVUs. So if one doctor was a full time FTE and another was a 0.75 FTE, those same two doctors could produce the same number of RVUs but the one at 0.75 FTE would only get 75% credit for their work. It was effectively a double hit. And far more women physicians than male physicians were part time in an effort to meet expectations at home to take care of their families.
I called it out over the course of several leadership meetings, and one of my male colleagues went so far as to note that obviously things would be different “if the room were full of part-time women doctors.” I reached out to the American Medical Association to see if the disparity was wide enough to meet criteria for an EEOC lawsuit, It was close, but not quite there. But it was very real.
There are lots of ways for gender pay disparities to occur and leadership to make it sound like everything is completely fair. This is just one example.
Thank you for sharing. Yes, I have seen this too. I worked in a group where everyone had the same rvu threshold for meeting a productivity bonus but women that took unpaid maternity leave would never have a chance of meeting the threshold would not be adjusted for FMLA leave time. So they were essentially getting a double hit on their income. The devil is often in the details.
Disha
With all respect to maternity, it is a personal decision of a woman and family. Want to make money then work hard, want to make a family then miss this year RVU productivity and then work hard next year.
Although I believe that wage gaps are common and I’m support efforts to correct them, I would advise you against using this example if you’re trying to persuade people. Pro-rating the threshold for FMLA time is not inherently more fair than everyone having the same threshold for the bonus; it just represents a different set of priorities and incentives.
If the threshold is the same for everyone, those who take time off for maternity or paternity leave have a disincentive to push harder for RVUs during the rest of the year because the bonus is out of reach. I would imagine that some men would either forgo paternity leave or take a shorter one to keep a bonus within reach.
On the other hand, if the threshold were pro-rated I would anticipate more folks (especially men) would take FMLA and those leaves would be longer. After coming off leave, people would be incentivized to push hard the rest of the year for the bonus. The big question how the group’s overall productivity compares for the two systems. If there is less overall bonus money available in the pro-rated system, it could lead to resentment from docs who didn’t take leave because they may feel that they are subsidizing the bonuses of those who did (versus docs who took leave resenting the bonus being out of reach in the non pro-rated system).
A man taking paternity leave is a wonderful choice – but a woman taking maternity leave is also a physical choice. She is recovering from bringing life into the world. What you fail to examine is the fact that medicine was made with the archetype of a male physician in mind. So there was never provision made for having a baby. It was also based on the archetype of “boomer men” who do not feel any hint of obligation or desire to take paternity leave.
Men do not have to carry children in their body for about 40 weeks. But a biological function that allows the human race to remain non extinct is natural for a woman to have and carry a child. To say if you choose to have a child you should be punished in medicine is ridiculous. That is like saying one should be penalized for breathing. The very set up is inequitable and needs to be re- examined.
We just have to reconsider the way that we do things because woman are in the field of medicine and they should not have to pretend to be a man “meaning not carry children “ in order to be able to thrive in medicine. That does not make sense!
Why should choosing to be a doctor mean you cannot have children? Does that make sense “Tiger “ or whatever your name is?
Thanks so much for listening to the episode!
So there is a lot of data out there that confirms there is indeed a pervasive pay gap in healthcare, just like there is in our society. I am happy to share numerous articles and data with you if you would like. Sadly it wouldnt all fit in the confines of time for a podcast episode.
And I am not a “leftist” or “political” person, just someone who feels people should be paid equally for doing equal work.
https://www.aamc.org/news-insights/new-report-finds-wide-pay-disparities-physicians-gender-race-and-ethnicity#:~:text=Major%20findings,across%20different%20departments%20and%20specialties.
I’m not sure that study is adjusted for work done. But there is a section comparing men chairs of departments to women chairs of departments, but I suspect that is influenced by the fact that women are more likely to chair the Peds, FP, OB departments. Even that would require Men Peds chairs to be compared to Women Peds chairs etc to really give apples to apples comparisons.
It doesn’t seem like it would be all that hard to adjust for all this stuff but it’s certainly more work than just adding up all the salaries, averaging them, and putting them into a chart like Medscape and Doximity do. Wish it was done more often. Not only would it convince those who don’t think there is a gap at all, but it would actually tell us what the gap that is due to discrimination really is. Once the problem is defined it can then be worked on.
Do you have an annual financial report for your Women in Medicine Summit?
On face value, you have a financial bias to push your current narrative. That is quite the list of sponsors and endorsements on your website.
Stick to the topic at hand rather than anonymous ad hominem attacks. This isn’t about Dr. Jain, it’s about the wage gap, its existence, its size, its solutions etc.
With respect, I disagree with your comment. Pointing out bias when dubious claims are made is not ad hominem. It’s an important part of the conversation when someone is financially incentivized to maintain a certain opinion.
It’s very different when you’re making anonymous criticisms of somebody who is not anonymous.
Maybe if we knew your real name we’d all Google it and find out you’re the CEO of the company with the biggest wage gap in the Fortune 500. Then we’d all know about your conflict of interest. See how that works?
Stick to debating ideas, not people.
Stick to debating ideas? How about the idea that it is important to disclose your conflicts of interest? Top sponsors to the Summit are pharmaceutical companies. Check the website.
There is big money in convincing others of a gender pay gap.
Why is a pharma sponsor relevant to this discussion? Or does pharma just = “big pockets” to you? At any rate, how do we know you’re not just as conflicted? We don’t. For all I know, you’re a pharma CEO.
Disclosing any potential conflict of interest is considered essential for the integrity of medicine. It wasn’t done in this case. I’m simply pointing that out.
I’m not the one who gave or conducted this interview. Nor do I own the company that hosted it. That’s on you.
Yes, pharmaceutical companies have deep pockets, and that’s a fact. I think it would be interesting and enlightening to see what the financials are for this upcoming Summit. Dr. Jain is welcome to respond and prove me wrong.
Hi TommyBoy,
I have made zero money from the Women in Medicine Summit to date. That may change in the future, but as of today, I have taken home 0 dollars from it. And the conference is run predominantly by volunteers who are also, unpaid. All funding that has been paid to the Summit has gone directly into programming up until now.
However, in the future, if I do end up taking a salary from the incredible amount of work it takes to put on a conference like this, I can’t imagine that should be an issue. Most people who have jobs, or do work, or have their “side gigs” get paid.
I also don’t think that should be an issue when discussing gender inequities. Whether I create the conference or not, the inequities will exist. There is mountains of data out there showing this is a problem. My conference exists to empower attendees of all genders to improve their professional career trajectories and stay in healthcare, harnass their innovation, love their jobs, find work/life “balance” and work towards fixing the systems within which we all work.
We would love to see you there in September, men have also found the content to be quite helpful.
Well said. And I will definitely agree that putting on a conference is a ton of work. It takes a real saint to do that for free. There would not be very many WCICONs if they were being run at cost or worse if we were taking a loss on them.
Thank you for the response. As I’ve said, I think disclosure of possible conflict of interest is important in medicine. Much respect to you for responding and even more so for the work that you are putting into this.
While I don’t agree with all of your reasoning for the wage gap, I do believe that it exists. I appreciate the fact that you are passionate about it and working to ensure equality.
I’m actually amazed to have run into a handful of people this week that don’t believe it exists at all or is actually negative (i.e. men being paid less for the same work.) It turned out to be far more controversial than I had expected it to be.
I also think it exists (on average) but is probably in the single digits once you control for appropriate confounders. So hard to do those studies though. The important thing is for each institution to go compare “like for like” jobs and see if they have one. UCSF and Johns Hopkins found one when they looked (single digit amounts) and cut checks and fixed salaries. I had one reader tell me they did the same at their institution and didn’t find one. Good for them.
I can understand why someone might not want to publish any “anti wage gap” studies too though given the amount of heat around this topic.
By your OWN admission, you and all of these people are doing all of this unpaid volunteer work. Congrats.
Your bias is to pretend inequities do not exist. You saying it does not exist is not consistent with reality or the history of this country.
Really enjoyed the discussion here, thanks to all of those that took the time to listen and comment. The gender wage gap is real and is pervasive throughout society, here in the United States, and around the world. Here are a few resources for those who would like to learn more.
From the Economic Policy Institute: A complete guide to the wage gap https://www.epi.org/publication/what-is-the-gender-pay-gap-and-is-it-real/
From the Pew Research Center: How the wage gap in the US hasn’t changed in 2 decades https://www.pewresearch.org/fact-tank/2023/03/01/gender-pay-gap-facts/
From the Nation Bureau of Economic Research: https://www.nber.org/system/files/working_papers/w21913/w21913.pdf
Regarding Physicians specifically:
Gender differences in salary in a recent cohort of early-career physician researchers: https://pubmed.ncbi.nlm.nih.gov/24072109/
Gender wage gap among medical specialists in New Zealand: https://bmjopen.bmj.com/content/11/4/e045214
Harvard business review: https://hbr.org/2019/11/how-to-close-the-gender-pay-gap-in-u-s-medicine
Canadian medical association: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944293/
The World Health Organization (WHO): https://www.who.int/news/item/13-07-2022-women-in-the-health-and-care-sector-earn-24-percent-less-than-men
“The gender pay gap in the health and care sector: a global analysis in the time of COVID-19 finds that, even with the COVID-19 pandemic and the crucial role played by health and care workers, there were only marginal improvements in pay equality between 2019 and 2020.
It also finds a wide variation in gender pay gaps in different countries, suggesting that pay gaps in the sector are not inevitable and that more can be done to close these gaps. Within countries, gender pay gaps tend to be wider in higher pay categories, where men are over-represented. Women are over-represented in the lower pay categories.
Mothers working in the health and care sector appear to suffer additional penalties. During a woman’s reproductive years, employment and gender pay gaps in the sector significantly increase. These gaps then persist throughout the rest of a woman’s working life. The report observes that a more equitable sharing of family duties between men and women could, in many instances, lead to women making different occupational choices.
The analysis also looks at the factors that are driving the sector’s gender pay gaps. Differences in age, education, working time and the difference in the participation of men and women in the public or private sectors only address part of the problem. The reasons why women are less paid than men with similar labour market profiles in the health and care sector across the world remains, to a large extent, unexplained by labour market factors, the report says.
“The health and care sector has endured low pay in general, stubbornly large gender pay gaps, and very demanding working conditions. The COVID-19 pandemic clearly exposed this situation while also demonstrating how vital the sector and its workers are in keeping families, societies and economies going,” said Manuela Tomei, Director of Conditions of Work and Equality Department at the International Labour Organization. “There will be no inclusive, resilient and sustainable recovery without a stronger health and care sector. We cannot have better-quality health and care services without better and fairer working conditions, including fairer wages, for health and care workers, the majority of whom are women. The time has arrived for decisive policy action, including the necessary policy dialogue between institutions. We hope this detailed and authoritative report will help stimulate the dialogue and action needed to create this.”
“Women comprise the majority of workers in the health and care sector, yet in far too many countries systemic biases are resulting in pernicious pay penalties against them,” said Jim Campbell, WHO Director of Health Workforce. “The evidence and analysis in this ground-breaking report must inform governments, employers and workers to take effective action. Encouragingly, the success stories in several countries show the way; including wage increases and political commitment to pay equity.”
Can you define pay equity vs. pay equality? I’m not being challenging with that question, but rather truly would like to understand what goals we are shooting for here.
Like many, I’m paid on an RVU basis. My partners (both men and women) are paid the same. Is that equality or equity in this case? Or both?
If this were true, all men would be out of jobs since everyone would hire women for less. Businesses aren’t charities.
As with any study, particularly ones that rely on statistics, it’s easy to get any conclusion you want. I can create 20 studies showing people who like pepperoni pizza make more than those who like double cheese. Doesn’t make it any more true. Concluding gender (more specifically sex since it’s 2023) as THE determining factor is a really shallow analysis of the issue that likely is caused by factors associated with being a woman rather than being a woman.
On a lighter note, this conversation reminds me of this:
https://m.youtube.com/watch?v=7ZPnCMVwQFk
Comments section was about what I expected…
As a male trainee in Canada – a country where there really should be no pay difference since it was truly “fee for service” with essentially a menu of what you billed and the government paid it out monthly – I saw huge differences between men and women. Indeed a recent JAMA study (cited below) reported at least 13% pay difference even when controlling for multiple variables. To me, some of it seems “cultural”. Male preceptors were on average way more money focused and keen to teach us how to maximize billing and utilize every code to its max. Female preceptors almost never talked about money. I would have to say on average men were more “hungry” as was often joked. Men picked up most of the extra shifts and did nights/OT as much as possible while women did less so. There was also more of a culture where men helped each other out more (I.e. boys club) while women competed with each other. Finally I think there is an overall opportunity cost that women pay for those that pursue family or part time work – less complex cases end up with them and less efficiency. There have to be actual explanations for why this is happening in a true fee for service system like this where sexism may play a part but is not the full story at all. Recent JAMA study on this here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784395
I’m going to open a hospital and only hire female physicians and make billions of dollars since I can pay them less.
“ This is a completely free and open invitation to women or anyone who identifies as female to come join us and just talk about money.”
Uhm- what is a woman?
Serious question? What is a woman? How do you “identify” as one? Are non-binary folx (sic) allowed to attend?
Hello, yes non-binary individuals are welcome. Anyone who feels they would benefit from this type of forum is welcome.
Disha
I’m a male. Can I attend?
Really?
Yes. It was serious and sincere question.
May I attend? I am a cisgendered white male with male sex organs and a Y chromosome.
Okay pal.
What part of “women’s happy hour” makes you think it is aimed at you, who has a Y chromosome, male genitalia and who identifies as a male? How does that meet anybody’s definition of woman?
Try to focus on the topic at hand, which is the gender wage gap.
Why was my comment deleted?
Probably because you told the truth. Lol.
Although I delete comments frequently, none of yours on this post were deleted. There was one held for moderation though, probably due to the Youtube link in it. Comments with links in them are more frequently held for moderation or even put in the spam folder. Just the way the comment filter works.
Our profession also claims Fibromyalgia and chronic Lyme Disease are real too…
There are plenty of happy hours, networking events, mentorship, scholarships, and preferential admissions/hiring for women. If you are stupid enough to believe this BS, you’re stupider than people who believed valproate was effective for mania.
If you’re so confident in your assessment, why comment anonymously?
Hamilton, Madison, and John Jay wrote the Federalist papers under the name “Publius”.
Are you going to criticize our founding father too? Oh wait- the I’m-oppressed-Brahmin/Kshatriya probably will.
Wow. You’re bringing in the caste system…
So you are not SC/ST?
I don’t think it’s fair for upper caste Indian Americans to claim oppression. I left Bombay because I am a Muslim, and we were genuinely oppressed by Hindu-ultra-right-wing-nationalist like BJP/Modi.
If you are not SC/ST you need to check your privilege.
“Wow” is not an argument.
That’s non sequitur. Your question also answers itself. The only reason to ask a question like that is in hopes to “cancel” the person you responded to.
I’m surprised at some of the comments on this post. Leftist propaganda? Wow.
I guarantee the detractors will not read the dozen articles linked by the author.
The anecdotes suggest there is a wage gap. Many studies suggest there is a wage gap. Common sense suggests there is a wage gap. Salary surveys suggest there is a wage gap. Walks like a duck, looks like a duck, quacks like a duck…
On average, male physicians work more…partly because their cultural rolls support and encourage this. Money prowess is psychologically connected to….well you know.
Women spend more time with patients. Women are over represented in lower paying specialties. Women miss more time due to child care duties and childbirth. Few men have birthed children…
I’ve seen pay disparities for women across my whole career. Generally, women don’t push as hard or as often for raises. Their self image is also less directly connected to financial prowess.
I’m aware that being a tall white male with no foreign accent was helpful to me as to opportunities and salary across my career. I didn’t create that situation, but I benefited from it. I was told this directly by several administrators who hired me when discussing these issues.
Let’s not kid ourselves.
“being a tall white male with no foreign accent was helpful to me as to opportunities and salary across my career”
Yes to this! I have literally been told this by higher ups and patients (not my current employer I must say). At first I thought that “we need more people like you” was reflective of my own inestimable worth, but in no uncertain terms I was corrected that “like you” means looks and talks like you…
There are exactly NO laws that favor men in the USA, and none that favor “white” men. I can give you countless (federal and municipal level) that are both racist and sexist against “white” men. Actual evidence, you know, the things you are supposed to based conclusions on.
Let’s not kid ourselves, Anthony.
Laws…who said laws. There are no laws involved in the advantages that I have accrued from being a tall, white, male.
Still, I’m certain I have benefited. My response to this benefit is to accept it with grace and humility, and help those less favored. Fair, correct?
Denying any advantages exist seems the opposite of gratitude. I’ve heard I’m downtrodden and less favored these days. That narrative does not help me. It could make me feel like a victim, I suppose. I’d rather take the good (and the bad) and help others.
I’m certainly unaware of any ways my lucky breaks (white, male, tall, above average looking, and intelligent) have harmed me. Certainly these were all just luck, like being born at a time when these characteristics have enhanced my market value.
All one has to do to confirm the cultural advantages of these traits is consider a magical solution: imagine what you would be if you had magical powers. Would you rather be a non-white, female…for all the many advantages they enjoy? How about a tall black male? I doubt it.
https://psmag.com/.amp/social-justice/the-problem-with-being-tall-male-and-black
Best of luck to you. I’m always going to feel like I was simply lucky. Right place, right time. Minimal cultural obstacles. I’m also always going to help anyone that I see that is not getting equal treatment.
“Few men have birthed children”
NO men have birthed children.
tongue-in-cheek, adverb
: with insincerity, irony, or whimsical exaggeration
But, thanks for that clarification.
While I’m sure this is not what you meant, I believe Will here was “triggered” because there are some trans men who have birthed children…
Lots of good discussion on this apparently hot topic on the forum too: https://forum.whitecoatinvestor.com/general-welcome/388970-discuss-latest-wci-blog-post-the-wage-gap-in-medicine
“Wage gap” is an inherently misleading term. It is illegal to pay women less for the same work as men, and if it were legal, I am sure HCA, Ascension and Kaiser would be thrilled as they could get the same labor for less money and increase their margins. Is there an “earnings gap?” Sure, but women getting paid less for the same work as men is patently false.
Notice how none of the people can counter this “common sense” who make all the opposite claims on this board? Oh yeah, we’re going on multiple posts already without a peep. I wonder why.
I’m not sure anybody can definitively prove or disprove the absolute existence of a true wage gap when appropriately adjusted. It’s tricky for sure.
That said, the bulk of the evidence IMHO points to there being SOME size of a TRUE wage gap due to outright discrimination. Better studies will define its size more accurately and then the real work begins.
I’m actually kind of amazed that there are so many “wage gap deniers” out there. Given the history of the world, wouldn’t you expect one? I mean, women couldn’t even vote in this country a little more than 100 years ago.
You said it yourself, it is hard to prove a wage gap exists… but then you turn around and glibly label those who have a different perspective than you and the interviewer and the interviewee “wage gap deniers.”
Non-aristocratic men couldn’t vote throughout the entire multi-million year history of the world until ~300 years ago, either.
Does that mean men without royal lineage should be screaming from the mountain tops that they are being historically oppressed in the absence of convincing evidence?
It is against the law for any company in the United States to pay women less than men on the basis of sex. We would see articles about these companies every day, if they existed, and these companies would, rightly, go out of business. But we never have, and I expect we never will.
I think your faith in the legal system to solve this issue is somewhat misplaced.
Do you really believe the wage gap is 0%? Really? Women are getting discriminated against left and right in this world but you think in this one instance of physician pay it isn’t happening? Really?
I don’t think there’s actual gap these days. There are people who accept lower income for less work and it can be both men and women.
Anyway, with today physician shortage, if you feel that you are not compensated fairly you can easily find a different place.
“Women are getting discriminated against left and right in this world but you think in this one instance of physician pay it isn’t happening?”
Again, making unprovable claims that we’re supposed to just go along with. I’ve noticed this a lot in the modern world = propaganda. Usually learned in college and to keep up with the current power brokers (who are closer to communist than ever before, btw) in the corporate and gov’t world.
I don’t need to have faith in the legal system to solve a manufactured problem. Is there an EARNINGS gap? Absolutely. Is sex alone the cause of the differences in earnings between male and female physicians, like WCI and the interviewee are claiming? No. Is sex a contributing factor? Maybe a small factor…
Is there a WAGE gap? Absolutely not. There is no billing code for physicians to collect for service provided by a male or female. There are no recruitment emails from companies advertising 100k signing bonuses (but 91k for women).
If I compared a paystub to a female colleague of the same experience and position, our wages would be EXACTLY THE SAME. We make the same exact amount per hour and collect the same amount per RVU. Our overall earnings might be different but that’s because there are many factors that go into overall earnings, though none are biological sex (or gender, for that matter).
I promise you that the way western media hunts for stories to stir up outrage, if they could find a SINGLE instance of a healthcare company paying a female physician 91% of her male colleagues for the same hours and labor, it would be plastered everywhere. Daily. For weeks.
You mean like this one?
https://www.ucsf.edu/news/2016/02/401571/ucsf-faculty-salary-equity-review-finds-few-gender-based-inequities?utm_source=feed&utm_medium=rss&utm_campaign=Feed%3A+UCSF+News
or this one?
https://www.hopkinsmedicine.org/som/_documents/2014_faculty_salary_analysis.pdf
While I agree with your main point (that the gap is NOT 31% or whatever commonly gets cited from terrible uncontrolled studies), I think it is just as unlikely that the gap is zero, especially when one was found when it was really looked for at not one but two institutions. If more would look, I suspect more institutions would find a gap. It’s not going to be 25%. But 5%? Sure. I bet that’s really common.
I take it you didn’t read your own sources ? The first link makes no mention of controlling for hours, rvus, etc. uses very vague language in “controlling” for variables.
“We are encouraged that this study finds that by and large, most women faculty at UCSF are paid equitably with their male counterparts,” Hawgood said. “We have already addres
The second link says it’s explained by hours work, additional shifts, etc.
I appreciate all you do and know your busy but these are not good sources imo.
I’m not sure there is any source that would be good enough for you.
Just because most were paid fairly doesn’t mean changes shouldn’t be made to make sure all are paid fairly.
Fixed overhead costs in any business should favor the full-time over part-time employees.
The incentives should favor working more, not less.
I understand this despite working part-time most of my career.
Complaining has paid (those days are running out), grievance culture has paid, victim culture has paid. And people wonder why we see more of it, lol
I think you’ve made your point and have now crossed the line into trolling.
You’re literally name calling. He made a valid point. Just because he disagrees with you, doesn’t mean he’s posting in bad faith (a troll). I think via Occam’s razor that he just doesn’t believe there is a wage gap (since nobody seems to be able to observe one with their own eyes), and that he’s posting in good faith. He just happens to say something heretical to your Diversity Inclusion Equity (DIE) secular religion, so you hit the cognitive kill switch and call him names.
Either way, you’re attacking him- not his argument… a literal *** AD HOMINEM ***
I think you’ve made your points as well. Unless you have something new to say, I think your comments on this post are done.
Every person who ever hired me was a white male. Every person who ever had an impact on my wages were white males.
At the first table I sat around with the other department chairs in 1997, there were no women in the room…who weren’t serving the food.
Every other inpatient psychiatrist with a side gig working weekends and holidays that I have met were males. Interestingly, they all had wives at home running the household while they were out procuring side gig money, myself included.
Most of the mid level and higher managers I met with from 1994 to about 2011 were white males.
All the CMO’s and CEO’s I worked for were white males. Almost all the program directors I worked for were white males. I remember one or two who were “not white”.
In my thirty year career, I did meet one white female department chair, who later became a CMO. She worked only three days a week the first two decades of her tenure as she had young children at home and her husband was an anesthesiologist who was on call frequently.
My residency training directors were males. The CMO that I took over for was a white male. Most of the Medical Directors I have known were males.
When I took a job at an institution that was run by a white male CEO who embraced diversity, the effects were quite apparent. Half the people at the “power table” were women. The COO was a woman. Several of the Vice Presidents were women. The doctors were from diverse backgrounds. The place celebrated diversity and it was vibrant. People loved working there. We delivered excellent care and all the salaries were posted. There were no wage gaps that I could see.
For me, everyone deserves equal pay and equal treatment under the law. I’m convinced that I benefited from systemic issues that have since eased somewhat. The wage gap has been shrinking. The playing field is becoming more level. In the past decade, I’ve seen more diversity and more female Medical Directors and high level administrators.
That’s a good thing. I have three daughters.
In studies outside of medicine, the pay gap between males and females disappears or shrinks dramatically when females without children are considered as a comparator. It is not a gender wage gap, it is a primary care giver wage gap. Just because many primary care givers are women doesn’t mean we should conflate this as an issue of gender.
Here is just one of many studies demonstrating this fact:
https://www.henrikkleven.com/uploads/3/7/3/1/37310663/kleven-landais-sogaard_nber-w24219_jan2018.pdf
Even the progressive NY Times acknowledges the truth of the situation:
https://www.nytimes.com/2017/05/13/upshot/the-gender-pay-gap-is-largely-because-of-motherhood.html
If a male gay couple of 2 physicians at the same spot in their career decided to adopt and one of the two became the primary caregiver, I would happily bet large sums of money that their salaries would diverge over the course of the next 20 years in a way indiscernible from the same couple with a female primary caregiver.
Yet, no study that I have discovered in the medical literature even includes child-bearing in the multi-variable analysis. This is an attempt to smuggle a desire for equity for primary child care-givers (an argument that very well may be valid) with gender discrimination. It is not gender discrimination, it is actually equality. If you treat everyone the same, you will discover a massive wage cap in those physicians without children and those that choose to be the primary care-giver for children.
We need to phrase the argument in terms of truth to fix it.
I came here to say the same thing.
When you control for children the gap disappears almost entirely.
The gender wage gap is more of a motherhood/caregiver gap. In fact, women under 30 without children make 102% of what men under 30 do in NYC (https://www.pewresearch.org/short-reads/2022/03/28/young-women-are-out-earning-young-men-in-several-u-s-cities/).
Personally, as a 42 year old childless woman, I think this is just fine. I’d choose a pay cut in a heartbeat if it meant I could have children. But I missed the boat on motherhood, partly *because* I put so much emphasis on building a career. If because of that I am more productive at work, I should get paid more.
This does not mean that sexism doesn’t exist. It absolutely does and is likely responsible for wage discrepancies in some situations. But I think focusing on the wage gap is the wrong approach. Instead, we should ask how can we support great doctors who are also moms, how can we restructure things so that women can take time off and get back into the workforce later and have a happy career, how do we help women negotiate salaries more confidently?
One more point: there was a recent study showing women uber drivers make 93 cents on the dollar compared to men. It is literally impossible for any of this discrepancy to be due to sexism. It is entirely based on the differential choices made by men and women.
Very interesting discussion
Out of curiosity, how do we define “wage gap”. This is semantics, but I think they are important to understand where we are to understand where we need to go. Personally, I would consider a “Wage Gap” to mean that there is a definitive difference in the wage someone is offered – a combination of guaranteed salary and rvu conversion factor. For example, if in an academic job an assistant professor received $25,000 and then $50 per RVU that would be their wage. If those numbers are identical at all places of employment (or whatever payment model is used) then there is no technical wage gap. If it were different between males and females or any other group then we for sure would have an argument for a “wage gap”. To that end, I had a discussion when I was in the military with a single physician saying that there was a pay discrepancy and bias towards married people and those with kids – this actually factual, military individuals with dependents get paid more with BAH, etc. This is a real gap and difference for equal work. By this definition, the military is (openly) in favor of its members to have dependents and pays them more because of it. As an aside for those who don’t know, being married without children counts for having a dependent so the military pays you more to be married than to be single. Just food for thought.
If on the other hand, those numbers are exactly the same however, the actual salary between groups is different then the focus of the questions would be on why are the groups producing different number of RVUs. I believe that the outcry of “wage gap deniers” as it was coined above is because objectively, utilizing the measures above, there is a lack of understanding what is meant by the wage gap if we are all offered the same pay rate. Now, the podcast was thought provoking for non-compensated jobs which are more frequently worked by females as compared with males, however this would also be multi factorial.
Finally, is there a male or female or non-binary or majority member or minority member out here who would like to have their name on a well designed study which says that the wage gap doesn’t exist (presuming this is true)? Given the responses here I’m just guessing the answer is no. Even if it’s the worlds best and most accurate study, given people’s personal biases it is a lose lose to publish such a thing.
Yikes to some of these comments and the recent firing by WCI
WCI ambassador Dr. Disha Spath has recently separated from The White Coat Investor but we encourage you to follow her continuing work in physician financial literacy at https://www.thefrugalphysician.com/. While it would be unprofessional to discuss the reasons behind personnel changes publicly, due to timing there has been some reasonable speculation on social media that this separation was related to a recent podcast episode about The Gender Wage Gap. We categorically deny any connection. The personnel decisions were made prior to that episode and we stand behind the content in that episode about this important physician financial issue 100%. We are proud to bring discussion of that topic to the physician financial space and are proponents of identifying and eliminating gender wage gaps. We feel Dr. Spath and her guest Dr. Jain made valuable contributions on the topic and most importantly, got the discussion rolling that will hopefully continue in The White Coat Investor community and elsewhere. We thank Dr. Spath for her hard work and service to The White Coat Investor community.
Here’s an example for you…
I work an oncologist for one of the largest nonprofit healthcare organizations in the US. I’m in a small hospital within the organization. My boss easily has about 18 years more experience than I do and has been head of the leukemia/lymphoma division at Hopkins, has been listed in the “top women in medicine” and inducted in the hematology heroes at ASH for he work in myeloproliferative disorders.
Why then do I have a higher RVU rate than she and all my other colleagues (who are all female in our hospital)?
To be fair, clinical productivity may not be the most important characteristic of the head of a department or division or a researcher etc. Our managing partner is our slowest doc in the pit but we put a ton of value on the other characteristics he brings to the group.