Female Docs Fall Further Behind On Pay

Women are playing a greater and greater role in medicine. But when it comes to salaries, they're actually losing ground.

A provocative study in the current issue of the journal Health Affairs finds female physicians' average starting salaries earned nearly $17,000 less than their male counterparts' in 2008, once researchers took into account gender differences in hours clocked, choice of specialty, and other factors.

And, strikingly, the trend for female doctors seems to be heading in the wrong direction. Back in 1999 the gender gap in starting salaries was $3,600 — more than $13,000 less than the most recent discrepancy.

The data come from a 10-year analysis of data from New York. Study authors think that's a good proxy for what's happening nationally, since New York leads the nation in number of residency training programs.

They also think starting salary is a good metric, because it avoids possible differences in productivity that emerge later in doctors' careers — due to time off for child-rearing, for instance.

Well, you may be thinking, women tend to go into lower-paying specialties, such as pediatrics, family practice and general internal medicine. So of course their average pay would be less. But it turns out that doesn't explain their recent slide in starting salaries.

In fact, the new study finds women are now no more likely to go into primary care jobs than newly minted male doctors. And those who choose high-paying sub-specialties such as cardiology, heart surgery, radiology, ob-gyn and anesthesiology all start at salaries thousands of dollars below comparable men.

Consider this: Starting cardiologists in 2008 raked in $228,188 if they were male, $204,671 if they were female. For radiologists, men made $250,709 and women got $244,532. And so on.

The $17,000 average gender gap is "unexplained," say Anthony Lo Sasso, a professor of economics at the University of Illinois, and his coauthors. That is, it "cannot be explained by specialty choice, practice setting, work hours or other characteristics."

For instance, it wasn't because women physicians are more likely to get paid a salary while men work on a piecemeal, fee-for-service basis, which can generate more income. Nor because women might be more likely to join a group practice while men might prefer working solo.

The trend is all the more striking because women are on track, finally, to reach parity in medicine. Now half of all medical students are women, up from only 9 percent in the mid-60s. Recent trends suggest about 1 in 3 U.S. doctors is now a woman, with further gains on the way.

So, could there be a backlash going on here? That is, as women become more prominent in medicine, could they be encountering more old-fashioned gender discrimination in the labor market?

The study's authors say they can't prove it, but they don't think so. Instead, they think the influx of women into the profession is leading employers to offer greater flexibility in hours and other family-friendly policies "that are more appealing to female practitioners, but that come at the price of commensurately lower pay."

It's also possible, they say, that women aren't as skilled at negotiating their starting salaries as men. But they think it's unlikely that women have gotten worse at negotiating over the past 10 years.

But even if women doctors are willing to trade off job flexibility for considerably lower pay, the authors think the trend deserves a closer look. For one thing, if the new Affordable Care Act survives in some form and millions more Americans get health coverage, the need for more doctors "will place a brighter spotlight on physician compensation," the study authors say.