Feb. 6, 2010 -- Among new physicians entering the work force, women earned almost $17,000 a year less than their male counterparts -- almost regardless of which specialty they picked -- according to an analysis of starting salaries over a 10-year period.

In fact, the analysis of starting salaries for more than 8,000 physicians found that the pay gap between men and women increased almost fivefold -- from $3,600 in 1999 to $16,819 in 2008.

The disparity could not be explained by the choice of specialty, type of practice, or working hours, Anthony T. Lo Sasso and coauthors wrote in the February issue of Health Affairs.

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"It is not surprising to say that women physicians make less than male physicians because women traditionally choose lower-paying jobs in primary care fields or they choose to work fewer hours," Lo Sasso, of the University Illinois School of Public Health in Chicago, said in a statement.

"What is surprising is that even when we account for specialty and hours and other factors, we see this growing unexplained gap in starting salary. The same gap exists for women in primary care as it does in specialty fields."

The findings came from a survey of 8,233 graduating residents and fellows in New York -- 4,918 men and 3,315 women -- all of whom accepted jobs during the study period. Consistent with national trends, women accounted for an increasing proportion of new physicians during the period, from 38 percent in 1999 to 43 percent in 2008.

Over the decade, starting salaries for male physicians averaged $187,385 a year compared with $158,727 for women.

Comparing starting salaries at the beginning and end of the review period, the authors found that new female physicians earned an average of $151,600 in 1999 versus $173,400 for men, a 12.5 percent difference. By 2008, the gap had increased to almost 17 percent, $174,000 for women doctors versus $209,300 for men.

Analysis by specialty showed that men started at higher salaries than women in all but two specialties -- gastroenterology, where women started at $209,392 compared with $206,158 for men and general surgery, where new female physicians held an advantage of $196,721 to $185,881.

Earning Less by Choice?

But the authors acknowledged that specialty choice did have some influence on the salary disparity, as women were more likely to go into lower-earning specialties, such as pediatrics (13.9 percent of women versus 5 percent of men) and ob/gyn (10.5 percent versus 2.5 percent).

Even so, the proportion of new women physicians entering primary care specialties declined substantially from 50 percent in 1999 to 30 percent in 2008 -- but the pay gap increased despite the entry of more women physicians into presumably more lucrative specialties.

When women physicians entered better-paying specialties, they still earned less than men. For example, in cardiac surgery there was a $27,103 disparity between pay for men and women. Other examples: a $32,207 gap in otolaryngology and $44,320 in pulmonology.

New female physicians also planned to spend fewer hours in patient care each week as compared with new male physicians, another possible reason for the disparities.

But after statistical adjustment for such differences, a substantial, unexplained pay gap persisted, the researchers noted. The $3,600 difference in 1999 did not reach statistical significance, but the $16,819 difference in 2008 did.

"It may be that lifestyle factors are increasingly important to newer physicians," said Lo Sasso, whose wife is an ob/gyn. "It could be that women in particular want to have more of a lifestyle balance in their medical careers."

The results came as no surprise to Dr. Molly Cooke of the University of California San Francisco, who has watched salary-negotiation strategies play out over her 30-year career.

She also agreed with Lo Sasso's assessment that lifestyle issues, in general, are more important to women than to men who enter the medical profession.

"I think that there probably are a certain proportion of women making lifestyle choices at the expense of salary," Cooke said in an interview with MedPage Today. "I know that if you look at specialty choice by gender and ask men and women what is important to them as they think about their future specialty in medicine, men rank money higher than women. I think that plays out some in negotiations."

Less Money, More Flexibility

Physicians have more flexibility in their work style, she added. If a female physician wants to work a certain number of hours so she can spend more time at home with her children, opportunities exist today that were not available when Cooke entered the medical work force.

Another possible factor in the pay disparity is that women are more likely to be married to physicians or other professionals than men are. The woman may find herself disadvantaged in negotiations, particularly if the husband is the one being recruited. In such cases, the practice or recruiter might be "just finding a job" for the woman, said Cooke.

Female physicians also have a tendency to sell themselves short.

"I have talked with a lot of residents who are completing training and looking for their first job," said Cooke. "It's not all that uncommon for women to say, 'I just felt so lucky that UCSF offered me a job. I'm so lucky to get to be here.' I have to say, 'You're not lucky to be here; we're lucky to have you.' A lot of women just don't do that much negotiating."

"I know that's a stereotype, but like a lot of stereotypes, there's a certain amount of truth in it," she added.