Practices must be careful to create a fair environment for all employees.

In first grade, I sat in the principal’s office (yeah, I did something wrong) but could not remember a word she was saying — it wasn’t good. But I do remember the sign on her wood panel wall: “Don’t tell your daughter to marry a doctor or lawyer. Tell her to become one.”

Well, fast-forward from the 1970s and as of 2017, a majority of new medical students are women — 50.7%, to be precise.¹ My wife, a pediatrician, did both marry and become a doctor. Great news, but I’m not sure what advice to give our daughter who is graduating college this year and will subsequently enter the job market. What does the sign on the wall read now?

A LOOK AT THE EVIDENCE

Women in the workplace have come a long way: In 1970, just 45% of women were actively working. Today, that percentage has jumped to 83%.²

However, according to a Glassdoor study, women are paid up to 6.4% less than men for the same job with the same credentials and education.³ This gap is slightly lower in academic centers, since often salaries are public and more credential based. If 6.4% seems like nothing much to be concerned about, consider how you would feel paying 6.4% more in taxes each year or every time you make a purchase.

In health care, some evidence supports that this gap may be even greater. A 2018 compensation report by Doximity shows the gender wage gap among physician specialties ranged from 14% to 20% less pay for women.⁴ Additionally, the researchers note that from 2016 to 2017 this gap increased in half of the top-50 metro areas.

A study of new physicians in New York State found the gender wage gap for doctors to be 17% less for women, a gap the researchers said could not be explained by specialty choice, practice setting, work hours or other characteristics.⁵

I should note that neither the Glassdoor nor the Doximity studies accounted for any maternity leave the female respondents may have taken, which may impact the wage gap they report. Likewise, the New York State study does not, its authors note, question respondents about marital and family status. Additionally, as the authors of the NY state study note, it is possible “physician practices may now be offering greater flexibility and family-friendly attributes that are more appealing to female practitioners but that come at the price of commensurately lower pay.”⁵

However, if the findings of these studies are due to discrimination, the economic consequences can become exponential. For example, over the career of a female physician a difference of $100,000 a year with interest could easily be more than $4 million. Even part of this money could be used to start a practice, pay for college or have money to retire more comfortably.

CALL TO ACTION

Often the topic of a possible gender pay gap gets dismissed, overlooked or considered too sensitive to discuss, but if we want to make sure it’s not happening in our own practices, we have no choice but to be proactive.

To employers, myself included, begin a discussion in your practice and make sure you have a written policy to hire and advance employees on merit and education rather than gender. Recently, our practice performed a review and saw a potential gender pay gap when hiring a new male employee. We corrected this by giving a raise to the female employee to fairly reflect her experience and degrees while avoiding the creation of a gender pay gap within our practice. This could have been overlooked if we were not constantly auditing ourselves for this concern.

To the women workers in health care, become an advocate. Know what average salaries in your region are for your position, experience and education. Regional salary surveys are published each year with this information.

There is room for everyone who wants to work in health care. But practices must be careful to create an environment fair for all employees. As I write this, the unemployment rate is below 4%, the lowest in more than 40 years, and the economy has been expanding for more than 10 years. Even in the “Great Recession” of 2008, health-care jobs were among the least affected. As you expand your practice, keep these facts in mind.

WHAT WILL YOU TELL THE NEXT GENERATION?

It is our responsibility to pave the way for our children. My hope is that one day this article is irrelevant. As a father of two daughters, I don’t always know what to tell them. There isn’t always a sign on the wall with the answer.

For the last 6 years, my younger daughter has written her back-to-school essay stating that she wants to work as a waitress at The Cheesecake Factory. Each year I coax her to consider something else, even telling her she could work at the restaurant on nights and weekends. Nope, she won’t budge. For now, I’ll have to accept her determination. At least I can hope for a family discount on a great meal.

Maybe the next sign should say, “Don’t tell your daughter to wear glass slippers. Tell her to break glass ceilings.” OM

REFERENCES

1. Association of American Medical Colleges. AAMC News. More Women Than Men Enrolled in U.S. Medical Schools in 2017. Dec. 18, 2017. AAMC News. https://www.aamc.org/news-insights/press-releases/more-women-men-enrolled-us-medical-schools-2017 . Accessed Oct. 10, 2019.
2. Lisa A. 50 ways the workforce has changed in 50 years. Stacker. Feb. 11, 2019. https://thestacker.com/stories/2481/50-ways-workforce-has-changed-50-years . Accessed Oct. 10, 2019.
3. Chamberlain A, Zhao D, Stansell A. Progress on the gender pay gap: 2019. Glassdoor Economic Research. 2019.
4. 2018 Physician Compensation Report. S.\econd annual study. Doximity. March 2018.
5. Sasso ATL, Richards MR, Chou C, Gerber SE. The $16,819 pay gap for newly trained physicians: The unexplained trend of men earning more than women. Health Affairs. 2011; 30:193-20. https://www.healthaffairs.org/doi/10.1377/hlthaff.2010.0597 . Accessed Oct. 14, 2019.

Scott LaBorwit, MD, is a principal at Select Eye Care, with locations in Towson and Elkridge, Md., and is an assistant professor, part-time faculty, at Wilmer Eye Clinic of Johns Hopkins Hospital, Baltimore. His e-mail is Sel104@me.com.

Disclosures: Dr. LaBorwit is a consultant to and speaker for Alcon.