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

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, 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.

Published on: March 25, 2011
Published in: Health and Health Care, Medicine & Business

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