Journal Club: Female Physicians Earn $2 Million Less Than Males Over A Simulated 40-Yr Career

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Article: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2021.00461?utm_medium=press&utm_source=mediaadvisory&utm_campaign=december2021issue&utm_content=whaley

Here at sheMD, we believe in the importance of practicing Evidence-Based Medicine. We believe the same principles apply to discussing Gender and Medical Education. Therefore, we are bringing you an entire Journal Club series! Our series will focus on foundational and new literature within the gender and medicine space.

Today, we will be discussing the article entitled, Female Physicians Earn an Estimated $2 Million Less than Male Physicians Over a Simulated 40-Year Career.

Why is this article important?

• It is well documented that there is a disparity between female and male physicians in compensation and opportunity, mirroring gender wage gaps in other areas of the United States labor market, despite the fact that females make up a significant portion of medical school students. Women are not only a large portion of medicine but also contribute substantially in areas of research, academia, community, and rural medicine. The critical portion of this report is recognition and quantification of the issue and efforts to amplify disparities. This study is the largest analysis of gender income differences in physicians, and it is the first to calculate the cumulative income differences over the course of a career.

Article Summary

What they looked at:

• This study evaluated survey data on physician income from 80,342 full-time practicing physicians in a variety of practice environments (academic and community centers) and across specialties from 2014 to 2019. They went further to simulate initial practice income over the course of a career and how the differences in income would change over time, adjusting for factors including experience, hours worked, specialty, location, and patient volume.

How they measured things:

• Survey data was collected through Doximity, an online physician platform which includes data on up to 70% of United States physicians. NPI-linked Medicare claims data was used to calculate total annual services performed by the physician for Medicare beneficiaries, number of beneficiaries, and total Medicare billing, in order to adjust for patient volume differences between genders. The study also utilized a multivariable generalized linear model in order to calculate adjusted differences in income by year of practice, with covariates including practice type, year of survey completion, and number of years out of training. They analyzed models for the ten most common specialties in medicine and weighted based on potential differences in gender response to the survey, Medicare workload, and practice type.

What were their outcomes:

• In comparison to male physicians, female physicians had a lower unadjusted and adjusted annual income (unadjusted $371,370 versus $270,547; adjusted $355,336 versus $312,799).

• In the first year of practice, male and female physicians had an unadjusted difference in income of $42,454. This only increased for the first ten years of practice, up to a difference of $90,298, and was stable after that. After adjustment, female physicians earned $19,731 less than male physicians in the first year of practice on average.

• Income differences varied by specialty, and they were similar in the first year of practice. However, by the tenth year of practice, the difference was larger in surgical specialties (adjusted difference of $54,777) than in nonsurgical specialties (adjusted difference $38,611) and primary care specialties (adjusted difference $30,245).

• The simulated difference in net value of career income after multivariable adjustment was a career difference of $2,043,881 ($8,307,327 versus $6,263,446). The difference varied across specialties, with the smallest difference in emergency medicine ($621,952) and the largest in orthopaedic surgery ($1,530,006).

Why do we care about this article?

What does this mean?

• There is a difference of over $2 million between male and female physicians over the course of a simulated career, even after adjustments for factors that may contribute to gender differences, such as specialty, years of experience, hours worked, practice type and location, and patient volume.

• Annual income differences accelerated from the first to the tenth year of practice and did not recover, leading to the idea that potential reductions in nonclinical responsibilities for women are not associated with recovery in income.

How does this apply to us?

• As healthcare professionals and a large portion of the workforce, this data is important in allowing us to be fairly compensated and recognized for our contributions. For trainees such as myself and those entering the workforce, it is vital to recognize the income disparity at initial entry into practice and that it rises in the first ten years of practice.

Take Home Point

• Income differences between male and female physicians rise in the first ten years of practice and culminate in a significant difference over the course of a career in medicine, even with detailed adjustment for other factors that may contribute to disparities.

• The vital work from here is our response–to intentionally work toward decreasing the outdated gender pay differences in medicine and supporting research and policies that aim to do so.

Similar Articles

• For further reading on the topic, check out these articles!

• Ganguli I, Rivara FP, Inouye SK. Gender Differences in Electronic Health Record Work—Amplifying the Gender Pay and Time Gap in Medicine. JAMA Netw Open. 2022;5(3):e223940. doi:10.1001/jamanetworkopen.2022.3940

• Jabbarpour Y, Wendling A, Taylor M, Bazemore A, Eden A, Chung Y. Family Medicine's Gender Pay Gap. J Am Board Fam Med. 2022 Jan-Feb;35(1):7-8. doi: 10.3122/jabfm.2022.01.210086. PMID: 35039406.

• Lo Sasso AT, Armstrong D, Forte G, Gerber SE. Differences In Starting Pay For Male And Female Physicians Persist; Explanations For The Gender Gap Remain Elusive. Health Aff (Millwood). 2020 Feb;39(2):256-263. doi: 10.1377/hlthaff.2019.00664. Epub 2020 Jan 22. PMID: 31967925.

• Hoff T, Lee DR. The gender pay gap in medicine: A systematic review. Health Care Manage Rev. 2021 Jan 29. doi: 10.1097/HMR.0000000000000290. Epub ahead of print. PMID: 33534271.

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