The Real Villain Behind the Atrocious Gender Pay Gap for Doctors

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According to Nora Caplan-Bricker at Slate, The Gender Pay Gap for Doctors is Atrocious. “Be they pediatricians or cardiologists, just starting their careers or at the tops of their fields, female doctors are paid significantly less than their male counterparts,” Caplan-Bricker writes of a recent JAMA Internal Medicine study. The absolute earnings discrepancy between male and female doctors averaged $51,315 a year.

Gender Pay Gap for Doctors

The study adjusted for many factors that impact compensation, including:

  • Age
  • Experience
  • Specialty
  • Faculty rank
  • Research productivity
  • Clinical revenue

After adjusting for those factors the average pay gap between men and women was still $19,878 a year.

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So what gives? It may be that the atrocious gender pay gap for doctors can be at least partially explained by one factor the study didn’t correct for: Flexibility in hours.

Economist Claudia Goldin has been studying the gender pay gap. Her research found, for instance, that female physicians earn 71% of what male physicians earn.

Goldin agrees with the Harvard Medical School and Massachusetts General Hospital researchers who found that the gender wage gap cannot be explained by differences in productivity between men and women.

“Instead,” says Heather Boushey, Executive Director and Chief Economist, Washington Center for Equitable Growth in a conversation with Goldin, “when we look at occupations, we see that there is a price paid for flexibility in the workplace.”

The higher the pay, the bigger the gap

Goldin explains first that the gender pay gap varies greatly by occupation. And that the gap is highest in the highest paid occupations. Even among doctors, the higher paid surgeons have a higher wage gap than the lower paid gynecologists and oncologists. Francine D. Blau and Lawrence M. Kahn, economists at Cornell, found the same thing as Goldin, that the gender pay gap is largest in higher-paying, white-collar jobs.

The high price of flexibility

According to the New York Times, one reason the pay gap is larger in higher paid jobs is that those jobs demand longer and less flexible hours

Research shows that “[the] gender gap in pay would be considerably reduced and might vanish altogether if firms did not have an incentive to disproportionately reward individuals who labored long hours and worked particular hours.”

The JAMA study didn’t correct for self-employment either.

The biggest gaps are in health occupations with high amounts of self-employment and the smallest gaps are in health occupations with very low levels of self-employment. Basically, eschewing self-employment means you’re willing to be paid less to have more flexibility.

And who is willing to be paid less in order for greater flexibility? Women. Women in high-end professions such as pharmacy, optometry, dental, law, medicine, and veterinary medicine are avoiding self-employment because self-employment in many of these professions offers very little workplace flexibility.

The motherhood effect

Why is the doctor gender wage gap so atrocious? Because women are choosing flexibility over pay.

And why are women choosing flexibility over pay? Motherhood.

Women in high-education, high-prestige jobs are taking big cuts in pay after having kids in exchange for flexibility and shorter hours. After having kids, “Women are moving into occupations that have more flexibility, but they are working fewer hours and getting less per hour,” Goldin explained.

“One of the worst career moves a woman can make is to have children,” writes Claire Cain Miller for the New York Times. Michelle Budig, a sociology professor at the University of Massachusetts, Amherst, found that  men’s earnings increased more than 6% when they had children (if they lived with them) on average while women’s decreased 4% for each child she had. While most of that gap for most professions is due to discrimination, according to Budig, there are also choices involved.

Goldin notes that after having kids, women make radically different choices in when, how, and where they work than men do. And these differences, such as taking short amounts of time off, have higher pay penalties in medicine than in other fields.

“Looking at data for the United States, we find that this change from being an employee, a worker, and a professional, to being an employee, a worker, a professional, and a parent has a disproportionate impact on women,” Goldin writes.

Other impacts

There are reasons besides motherhood for women to want flexible jobs. For example, in most relationships, both partners work these days. However, in heterosexual relationships, usually the man earns more. Which incentivizes women to choose geographically flexible careers so they can follow their husband’s job. “This factor is both a response to and a cause of the gender pay gap,” Claire Cain Miller wrote in a different New York Times article.

Another issue is that as professions move from majority-male to majority-female, pay drops.

The problem with the solution

Goldin points out that it’s common to blame the motherhood penalty on the United States’ “really lousy coverage in terms of parental leave policy, and in terms of subsidized daycare” compared with other developed economies.

Indeed, more than three-quarters of mothers and half of fathers reported in a 2015 Washington Post survey that not having access to childcare caused them to miss work opportunities, or forced them to change or quit their jobs. Part of the reason for this is that in many cities across the US childcare costs more than college tuition. Which is part of why Democratic nominee Hillary Clinton intends has promised to cap the cost of daycare at 10% of a family’s earnings via tax credits and subsidies.

And according to Miller, “Paid family leave helps” to close the occupational gender pay gap resulting from motherhood.

Other countries have tried subsidizing daycare and offering generous family leave.

“There are two very interesting papers, one for Sweden and one for Denmark,” Goldin said. “Both countries have policies that are just about the best in the world. And the same sorts of things are going on even in countries that have incredibly good parental leave policies, subsidized daycare, schools that appear to us to be better, and what we think of as social norms that are better.”

The result? Like in the US, the gender wage gap is higher among white-collar workers than blue-collar workers. And there’s a negative correlation between parental leave and salary for white-collar workers.

Goldin:

Even in countries with generous parental leave benefits and childcare help, women still choose to take the pay cuts and to shoulder most of the burden of childcare. Why? Maybe women just want to do this. Maybe they feel pressured to be the ones who take on that burden. It’s true that childbirth and breastfeeding are biological realities which incentivize women, and not men, to take a step back from careers after becoming parents. However, after the first or second year, why does this gap persist?

The real way forward

There are no easy fixes to the gender pay gap, whether for doctors or anyone else. Because so little of it arises from pure gender discrimination, you can’t just litigate or legislate it away. Instead, it arises from myriad subtle preferences and choices.

Here are some things that would help close the gender pay gap:

  1. Encouraging men to take time off of work so women can get back to their jobs sooner after giving birth
  2. Encouraging men to take primary responsibility for doctor’s appointments, picking and dropping off children from childcare, and staying home with sick kids
  3. Encouraging employers to making hiring, pay, and promotion decisions based on outcomes instead of whether a doctor is willing to work long, straight, inflexible hours

None of these is a panacea. And none is easy.

What else would help? Would more transparency in pay be worth the loss of privacy? Let me know in the comments.

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Cathy Reisenwitz

Cathy Reisenwitz is a former Capterra analyst.

Comments

[…] study by researchers at Harvard Medical School and Massachusetts General Hospital uncovered an “atrocious” wage gap for doctors and other medical practitioners that grows more staggering with every rung up […]

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Great article, Cathy! Just curious if physicians who choose locum tenens work are factored in to any of these studies? Self-employment looks to equal private practice from what I read. Also, have any of these studies started looking at the flexibility practicing via telemedicine?

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