Pay remains lower for top-ranking women in academic medicine

By Dr. Liji Thomas, MDMar 2 2020

Women cannot win; it seems. A new study published in March 2020 in the journal JAMA Internal Medicine shows that despite rising to the top of their profession, female heads of clinical departments continue to receive only 88% of the pay that their male counterparts earn, on average. This works out to a difference of about $70,000 to $80,000 per year. Furthermore, this is not an aberration, but a finding that is prevalent across the spectrum of public medical schools.

The difference remains obvious even at the top – for women who are incredibly productive academically, with specialized expertise and the most significant experience in their professions. As researcher Eleni Linos comments, "These women are at the top of their game. They are skilled leaders, outstanding managers, and experienced negotiators who have reached top positions in their medical schools."

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The study

The researchers looked at salary information from almost 30 public medical schools in 12 different states. They looked at the mean pay drawn by 550 clinical department heads in 2017. About one in six of these were women.

They then adjusted the salary to account for differences between temporary and permanent posts, for the differences in the cost of living in different regions, for the period in which each department head had held his or her position, and for the branch of academic medicine.

Finally, they controlled for the number of papers and other publications in the academic field, and for the grants, the researchers had obtained from the National Institutes of Health.

The findings

The study shows that the female heads of departments had to settle for about $80,000 less per year than men who occupied the same posts. After adjusting for experience, tenure period, specialization area, the difference held good to the tune of $70,000 per year.

Finally, even with grants and publications taken into account, there was a disparity of about $64,000.

Linos goes on to up-end the conventional views about the disparity in payments for the same jobs: "Gender pay gaps are often blamed on women's personal choices to reduce work hours or leave the workforce, household responsibilities, childcare or suboptimal negotiation skills. This study challenges these traditional explanations because our sample of medical department leaders has navigated these complex challenges and broken through the 'glass ceiling.' However, women are still paid less than their male peers when controlling for many factors."

Implications

The new study brings to the forefront of the existence of gender discrimination within the highest positions of academic medicine. The issue has been brought out into the light before, with a 2013 study published in the same journal highlighting a pay gap of about $51,000 between male and female physicians at American public medical schools. After adjusting for multiple variables, a disparity of $20,000 remaining.

Still, more recently, a survey of American medical faculty salaries in 2018 revealed that at all ranks, gender disparity in pay is alive and well. Another study showed that at entry-level, new medical residents got $17,000 more if they were men, on average, compared to women.

At every level, and in most medical specialties, the men were paid significantly more than the women. The higher the post, the more significant the pay gap. Moreover, this meant that women were paid 90% of the salaries that men earned for the same post in any medical discipline. However, in clinical fields, women got only 77% of the pay given to men in comparable positions.

She concludes, "This calls into question the common explanations for gender disparities and highlights a pervasive structural problem that needs to be addressed. Our study shows the pervasiveness of gender inequities at all levels of academic medicine."

However, earlier studies have led to fledgling efforts to bridge this gap. Many medical schools have set in motion the processes to assess pay equity, justify deficiencies based on performance, and if this cannot be done, to ensure proper compensation for both men and women in medicine. They use statistics extensively to come up with an accurate picture of how the pay system works, to highlight current disparities, and take corrective measures.

However, there are inbuilt differences even then because the statistical tools used depend on the number of women in leadership positions, which is already low, as the current study shows. Thus, institutions have their work cut out for them. They need to not just identify deficits in pay but to help women advance their medical careers. For instance, some schools "stop the clock" to allow women to have babies without affecting their tenure or promotions. Furthermore, in radiology, in particular, the gender pay gap has almost disappeared, from a 20% disparity in 2013. It may be instructive to notice that radiology has among the highest number of women in leadership compared to other medical fields.