The Hastings Center Report

September - October 2014

Vol. 44, No. 5

Highlights

Editor's Podcast

This podcast player requires theAdobe Flash plug-in. You may also download the MP3 file via the podcast feed.


Subscribe

Order the Hastings Center Report
Explaining the $17,000 Gender Gap in Physicians' Pay
Medicine and Business
Shara Yurkiewicz, 03/25/2011

Explaining the $17,000 Gender Gap in Physicians' Pay

(Medicine and Business) Permanent link

A study last month in Health Affairs found that the gender pay gap for starting physicians had widened from $3,600 to nearly $17,000 over the last 10 years (after adjustments for specialty and hours worked). The authors hypothesize that the main reason is that women are intentionally choosing lower-paying jobs because these jobs provide greater flexibility and family-friendly benefits. Though they do not deny that gender discrimination may exist, they doubt that it has gotten worse in the last decade, writing that "it would be difficult to believe that discrimination, after a period of quiescence, has actually been on the rise in recent years.”

This is the hypothesis that the media has picked up on: female doctors earn less than males because of the career choices they make; that’s unfortunate but it’s not unjust.

But perhaps this theory has been accepted too readily.

I do not know if gender discrimination is on the rise, but I do believe, based on personal experience, that it is still a major problem in the medical community. I am a first-year medical student who writes for Medscape's The Differential, a blog read by medical students and residents around the world. These are the people who will eventually be our colleagues and employers. I wrote a post that included anecdotal and statistical evidence about why we should not be so quick to discount sexism as a possible cause of the physician pay gap. It received the lowest average rating I have ever gotten for a post.

It also received several dozen comments. I have excerpted seven of them. All but the last one excerpted were within the first eight responses to my post, representing what I believe is the knee-jerk reaction to claims of sexism.

The first commenter argued that gender discrimination was logical based on biological differences, specifically those that occur during pregnancy and childbirth:

“If a male and female both apply for an important position . . .and they have the exact same qualifications, and perform exactly as well as each other in the interview, (and seeking the same salary, if this is negotiable) . . .As the employer, who would you hire? For a female, the opportunity cost of childbearing . . . represents a huge loss of utility for you, the employer. She would be unable to work during the final 6 weeks of her 40 week gestation (and will most likely have maternity leave for much longer than that). Furthermore, the hormonal and mechanical factors of childbearing will greatly reduce her ability to perform at her best during weeks 28 - 34 of gestation (e.g., going to the toilet every 30 seconds).”

Some commenters agreed with this “biological” rationale.

“I think the only way a woman . . . could demand equal payment with the other sex is to prove that they are incapable of having children. . . . I'm very sensitive to the equality of women, but we must also be careful about 'overswinging’ the pendulum.”

“II think job opportunities, salaries, roles, and available activities for both men and women will never be totally equal, and that has nothing to do with sexism but biology.”

Other commenters argued that discrimination did not exist or that women were actually being favored:

"Men are judged solely on how much money they make and therefore work harder to make more money. Women are not judged solely by their salaries and numerous studies . . . have shown that women make different choices in where they study, what they study, how long they study, what extra work they do, etc that all explains the gender gap in salaries. Work done… shows . . . that there has not been gender bias in medicine since the 18th century . . . look at med school admission rates that far back and it has been proven.”

"I completely agree, after reading this article I feel that these feminist views further support my belief that no matter how equal job opportunities, salaries, roles, etc becomes, certain women will never be satisfied. I feel "Hyperfeminists" are the reason why some men make sexist jokes or feel that women are treated unfairly well (i.e., admission into higher education is highly favorable for women at this time).”

One commenter was simply angry with the claim of sexism entirely:

"Of course there are those people who want to see sexism every where because it helps explain their own lesser position.”

I am disturbed by the immediate responses for two reasons: 1) the community they come from, and 2) the fact that the comments are fairly well thought-out and presented as logical, non-sexist perspectives.

These commenters believe that it is legitimate to discuss average differences between two groups (males and females); I do not disagree. But when does a preference for particular individuals constitute an “ism” (which is both unethical and illegal in hiring)?  Discrimination based on race, religion, and age is illegal. But what about weight, health, or attractiveness? What about professions where strength, youth, or physical appeal is desirable? At what point can employers choose their workforce without being accused of an “ism”?  

I don't pretend to have all answers for all situations, and so I am narrowing my scope to gender in medicine. The comments, I believe, constitute a form of sexism.

To help clarify, I would like to define an “ism” using a few criteria. A preference is discrimination when:

1) decisions such as those about hiring people and setting their pay rate are based on generalizations about the demographic groups to which individuals belong

2) individuals have no control over the group to which they belong – and it is apparent from their appearance.

3) it is nearly impossible to predict how an individual will do the job based on the group to which he or she belongs.

The commenters claim that their views are grounded in the economic model we work within. That is fair, but – wrongly, I believe – there is nothing said of the normative, or "what ought to be." Without this consideration, there is no impetus to address existing inequalities on a larger scale, which would involve a shift in mindset about traditional gender roles.

Sadly, my experience was not unique. Another female first year medical school student, Emily Lu, brought up concerns about the gender pay gap in a post on a major health care blog, KevinMD.com. She later reported, “Everyone from family practitioners to the wannabe policy wonks that troll such blogs were unconcerned by the trend and did everything they could to explain it away. Clearly, my commentators claimed, women were just working less based on some unmeasurable trend, seeking nonmonetary benefits, or spending more time with patients.”

Thankfully, during my Medscape debate, later commenters noted the implicit sexism in some of the earlier posts. One commenter summed it up particularly well:

"Reading this thread I am impressed by the amount of tacit sexist comments and thoughts made by supposedly intelligent, 'progressive' students. I think it partly explains why we see this widening of the gap – just bringing up the idea of gender equality elicited such responses as, 'we must also be careful about "overswinging" the pendulum,' (um, aren't we talking about how we're actually moving in the opposite direction?), and 'there are those people who want to see sexism every where because it helps explain their own lesser position' (the entitlement of this comment makes me nauseous). Even more troubling is that these students seem to lack the awareness of how their comments come across, as if they wouldn't consider themselves sexist in the first place. I'm grateful to see some responders on here that seem as equally appalled as I, but the ratio of ignorant sexist comments to intelligent ones is disheartening.”

Perhaps comments only select for the most vocal opponents. But these are their attitudes, and one day they will be choosing our starting salaries.

Shara Yurkiewicz is a student at Harvard Medical School.

Posted by Susan Gilbert at 03/25/2011 12:51:10 PM | 


Comments
This post is not very compelling. Basically you claim sexism accounts for gender differentials in pay, and if someone argues with you, you dismiss it a "knee-jerk reaction" to claims of sexism. Your account for why sexism accounts for gender differentials in pay was not very compelling either. I'm tempted to dismiss it as a knee-jerk reaction to data (or a knee-jerk pre-emptive reaction to claims of not-sexism). This explanation would be much more consistent with your self-described "hyperfeminist" radar. And finally, your anecdotes about medical school were not very compelling. My medical school experience was exactly the opposite: Women tended to ask more questions in lectures as well as in small groups, and in the small groups the faculty members picked students at random to initiate the introductions.
PS. I am a woman.
-Allison Tsai
Posted by: drdrtsai@yahoo.com ( Email ) at 3/28/2011 11:04 AM


In response to the last comment, I wonder if you'd find this argument I wrote more compelling (which I linked to in the Medscape post). It's based on statistics and not anecdotes.

http://bit.ly/h1vsYH
Posted by: shara.yurkiewicz@gmail.com ( Email ) at 3/28/2011 12:50 PM


I agree with the author that the comments in response to the $17,000 per year pay gap are as disheartening as, or may be worse than, the pay gap itself. To what do the negative commenters attribute this gap? While choices made by women could be an explanation, are those choices free of any sexist influence? Many of the remarks evince little understanding of what sexism is, and how it manifests itself in subtle, and sometimes even seemingly benign ways.
Posted by: sapel@vermontlaw.edu ( Email ) at 3/28/2011 2:59 PM


@shara: No, I don't find your Medscape post any more compelling. The central thrust of your Medscape post is that a P-value of 0.08 could be _socially_ significant even if not _statistically_ significant. Which is basically the same argument that your attendings (once you start your clerkships, that is) will make on teaching rounds, i.e., "This study's finding is statistically significant, but is it _clinically_ significant?" But if a P-value of 0.05 is good enough for the FDA and its drug approval recommendations, then why isn't it good enough for you? And that brings me back to my initial argument about how we are not really debating statistics here. The authors of the paper, who have no political axe to grind, were more inclined to dismiss the marginally statistically significant P-value as simply a not statistically significant P-value. You, on the other hand, have a 'hyperfeminist radar' that is primed to say "Aha! The P=0.08, which is only 0.03 away from 0.05". If the P-value were 0.20, you would comment that it is only 0.15 away from 0.05. And so on and so forth. I think your radar is driving your statistical critique rather than the other way around. You would make a much more compelling argument if you started from that basis rather than trying to fake like it is the other way around.
Posted by: drdrtsai@yahoo.com ( Email ) at 3/28/2011 4:41 PM


Expecting a zero pay gap presumes that there are no differences between men and women, when in fact there are significant differences, actually dichotomies, in terms of motivation. In order to attract a high value mate, men have to compete with other men for their rank in the male dominance hierarchy and this translates directly into men contesting each other for positions within organisations. There is no parallel for women.
Posted by: martin@martinsewell.com ( Email | Visit ) at 9/25/2012 10:01 AM


For sports that require fake oakley sunglasses a mix of eye-hand coordination fake oakleys and clear vision, for example tennis,it's easy to see replica oakley sunglasses why something as simple as a set of sunglasses can help you replica oakleys achieve better oakley sunglasses sale performance in your sport of choice.
Posted by: rasvpxwm439@hotmail.com ( Email | Visit ) at 4/20/2013 3:38 AM


Your knowledge of this subject comes through clearly in this article. I love to read this kind of articles, I hope you will update it. Thank you for sharing it with me.
Posted by: chenghuiaa123456@163.com ( Email | Visit ) at 5/15/2013 1:42 PM


When hungry, eat your rice; when tired, close your eyes. Fools may laugh at me, but wise men will know what I mean.
Posted by: ni.royak12@gmail.com ( Email | Visit ) at 6/26/2013 1:37 AM


I do think that if we want to enough,we 'll learn. more ,thank you for your blog
Posted by: miksonjacket@outlook.com ( Email | Visit ) at 6/30/2013 11:12 AM


Its a huge difference. But i think doctors in america already getting a good pay.
Posted by: stephenecarney@gmail.com ( Email | Visit ) at 9/5/2013 8:43 AM


An authority should regulate all these things.
Posted by: hugeskatherine@gmail.com ( Email | Visit ) at 1/22/2014 11:56 PM


it could be hard to get concert seat tickets, buying live performance tickets on the web is very popular than that ever continues to be and this kind of trend will be continuing inside popularity. There are numerous online seat tickets vendors supplying substantial special discounts, though you will need to be cautious as there are numerous concert and also event admission websites offering "not being missed discounts".
Posted by: johnlaw827@yahoo.com ( Email | Visit ) at 3/3/2014 6:39 AM


A finance calculator allows you as a possible individual to accomplish many factor. Most crucial is a finance calculator will assist you to make intricate financial data.
Posted by: johnlaw827@yahoo.com ( Email | Visit ) at 3/3/2014 6:39 AM


About these web sites, booking travel arrangements to places on domestic along with international routes can be carried out in few basic steps. A plus side to them is which they offer details of flights making use of their costs, for travellers to produce the arranging decision in accordance with their price range.
Posted by: johnlaw827@yahoo.com ( Email | Visit ) at 3/3/2014 6:40 AM


Really impressed! Everything is very open and very clear explanation of issues. It contains truly information. Your website is very useful. Thanks for sharing. Looking forward to more!
Posted by: rodneysingle716@hotmail.com ( Email | Visit ) at 6/13/2014 3:13 AM


A gap in salary is might be due to several reason. As compare to females males are more active on the job. But there are few jobs in which this gap should be minimize as the jobs related to health care needs special attention so the females can better perform that job.
Posted by: stephenecarney@gmail.com ( Email | Visit ) at 7/9/2014 12:18 AM


thanks for article
Posted by: nuzululhakim@hotmail.com ( Email | Visit ) at 7/15/2014 12:53 AM


Wait, till you have to offer employee benefits, it gets tougher... Here are few tips to make shopping for employee health insurance easier.
Posted by: hyderali.urgetech@gmail.com ( Email | Visit ) at 7/22/2014 2:15 AM


Whether you work in the construction sector or other area that requires stringent health and safety services, training staff in health and safety will be beneficial to both them and the company in the long run.
Posted by: hyderali.urgetech@gmail.com ( Email | Visit ) at 7/22/2014 2:16 AM


The complete health care programs today are especially designed for people with special needs and who need to stay in their home.
Posted by: hyderali.urgetech@gmail.com ( Email | Visit ) at 7/22/2014 2:16 AM


Unfortunately for some people, they have to travel long distances to the first pet shop in the nearest neighborhood. Count the fact that one will have to take all of the supplies he/she needs on his/hers own, again traveling that long way.
Posted by: hyderali.urgetech@gmail.com ( Email | Visit ) at 7/22/2014 2:16 AM


Health of your pets is very important. One cannot compromise with the health issues as it can later on lead to conditions which are difficult to avoid.
Posted by: hyderali.urgetech@gmail.com ( Email | Visit ) at 7/22/2014 2:16 AM


Your blog keeps getting better and better! Your older articles are not as good as newer ones you have a lot more creativity and originality now keep it up!
Posted by: rodneysingle716@hotmail.com ( Email | Visit ) at 7/31/2014 5:17 AM


Last round of qualifying, Hong Kong Yang Shihai couples in promotion hopeless cases rick north Korea dark horse, promising line of Replica Versace Belt Taipei thank combination defeat to south Korean chess player, the results of the two games help thank song combined with small advantages thrilling monitor to qualify. To be able to get a silver medal, should thank them. Look at the Asian games in the competition, we is what to do with Hong Kong and Taiwan compatriots: cycling play crash, [url=http://www.artandframingclub.com/]versace belt replica[/url] was definitely win Hong Kong sister bumped into serious injury; Taekwondo black whistle blowing (the whistle is not our main blow, but we are the host, suspected crime), by means of fishing law enforcement will threat to Replica Versace Belt player to win the most of Taiwan's younger sister out of the games ahead of the field. Let's go back and say, tell me about the dish. Various media to release the latest news today is that the south Korean chess fan spoiler of the decisions of the referee, requirement and the organizing committee open move. The organizing committee official said, for maintenance go image and two south Korean young professional chess player's reputation, temporarily not announced last 30 hand spoiler spectrum. The Replica Versace Belt showed how generous! How noble moral! What is a spoiler? Fill the child must be a spoiler? Look from the referee to suspend the game in a move, PiaoLi disruption to Liu Tang made available on the trouble, if they keep stirring, Liu Tang will no doubt. This shows PiaoLi spoiler during each chess under the Liu Tang bing, this call play will go terms. PiaoLi fill, whether to yourself to fi [url=http://www.artandframingclub.com/]cheap versace belt[/url] ll in the empty, or fill in the empty to each other, [url=http://www.artandframingclub.com/]versace belt cheap[/url] if it is invalid, according to the rules of Liu Tang all can PASS, don't take their own time. This is clearly not the case, fill to Liu Tang PiaoLi had made a lot of trouble, this is different to the network game in the heels. Career took things, commonly used tactics, which would be seconds when the purpose is to win some thinking for their own time, although go from a purely technical point of view, the play will be meaningless, also will waste of material. Since made of seconds tournament can allow players using time to think for themselves in the future, why in supply system of the events cannot allow players to use the future consumption opponent in time? I understand the same tactics is a kind of time.
Posted by: mbtning@gmail.com ( Email | Visit ) at 9/10/2014 10:46 PM