Physician practices with more female doctors have smallest gender pay gaps

July 30, 2020

In medicine, men generally earn more than women for similar work, but a new study published July 30 in BMJ finds that the income gap between genders shrinks substantially in practices with more equal gender distributions of staff physicians.

The analysis showed that in nonsurgical specialty practices with at least as many women as men, men earn 12 percent more than women. However, that gap nearly doubles--to 20 percent--for practices with more than 90 percent male physicians on staff.

In absolute terms, this means that in nonsurgical specialty practices with 90 percent male representation, female physicians earn as much as $91,000 less per year than their male peers.

The study's senior author, Anupam Jena, the Ruth L. Newhouse Associate Professor of Health Care Policy in the Blavatnik Institute at Harvard Medical School collaborated with researchers from the Rand Corporation, the University of California, Berkeley, and Doximity.

The findings offer important evidence supporting the notion that diversity in the workplace may have a positive effect on reducing earnings gaps and other inequities, the researchers said.

"There are many good reasons to have greater diversity in our workplaces, including the idea that if you make a workplace more diverse, some of the pay inequities we see will go away," Jena said. "This is exciting evidence that diversity can improve equity, not just in terms of representation, but in very tangible economic terms."

The researchers analyzed data from a national survey of physician salaries in the United States from 2014-18 that included 18,802 physicians from 9,848 group practices. They compared earnings across practices with different proportions of male and female physicians, adjusting for physician specialty, years of experience, hours worked, measures of clinical workload, practice type and geography.

Research into workplace diversity and income equity has been scant at best, the study authors said, in part because it is difficult to combine information about an individual's income and demographic information about their workplace. This survey assigned each doctor a unique practitioner identifier number, which allowed the researchers to compare information about respondents' individual incomes against demographic information about the practices where they work. Doximity conducted the survey and owns the database containing practice demographic information.

The researchers found that among 11,490 nonsurgical specialists, the absolute adjusted difference in annual income between men and women was $36,604 for practices with less than 50 percent male physicians compared with $91,669 for practices with at least 90 percent male physicians.

They found a similar distribution of incomes among 3,483 surgical specialists, with absolute adjusted gender differences of $46,503 in annual income for practices with less than 50 percent male physicians compared with $149,460 for practices with at least 90 percent male physicians. The relative difference in pay for surgical specialists was 10 percent in the practices with the most women compared to 27 percent in practices with more than 90 percent men.

Incomes were not affected by gender representation among primary care practitioners. Among the 3,829 primary care physicians in the sample, differences in income for men and women did not vary according to the proportion of male physicians in a practice. The researchers said that this was likely because there is less variation in income among primary care physicians. Primary care is among the specialties with the highest proportion of female physicians.

The researchers said that one likely explanation for greater equity in practices with more women was that the experience of working with women might change some of the implicit and explicit biases that many people hold about women in the workplace. They also said that women who were hired by practices with more female physicians might face less difficulty negotiating parameters such as how long they are allowed to spend with each patient, how long it will take to become a partner and other factors that impact earnings over the long term.

"For a woman negotiating the initial terms of her employment with a new practice, there might be a real difference if you're sitting at the table with five men compared to if there are three men and two women," said Christopher Whaley, the study's lead author and policy researcher at the Rand Corporation.

Whaley said that the wage gap would fall by about 20 percent if practices had more equal gender representation.

"Our findings suggest that increasing the gender diversity of specialty practices would do a lot to close the pay gap between men and women in medicine," Whaley said. "Yet another reason to push for greater diversity."
This study was supported by the National Institutes of Health, Office of the Director, (grant 1DP5OD017897), the National Institutes on Aging (grant 1K01AG061274) and the Nicholas C. Petris Center on Health Care Markets and Consumer Welfare.

Harvard Medical School

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