Physician Gender Pay Gap: Link to Work-Life Balance Found Unlikely

A full understanding of the causes of the pay gap between male and female physicians remains elusive.

New research shows the gender pay gap for physicians has persisted into recent years, and the study casts doubt on whether female physician preferences on work-life balance play a significant role in the pay gap.

American medicine was a male dominated field through most of the 20^th century. Researchers have found a persistent and widespread gender pay gap among physicians, including a Journal of Hospital Medicine article published in 2015 that showed female hospitalists earned $14,500 less than their male counterparts.

The new research, which was published recently in Health Affairs, focuses on physician starting compensation because the approach excludes many variables, the researchers wrote. "Information about new physicians accepting their first non-training position is valuable, as it minimizes unobserved differences in productivity and work experience that may confound analyses of a wider range of physician seniority."

Research data

The study examines 1999-2017 survey data from New York State, featuring survey responses from 9,000 men and 7,000 women. To gauge the impact of more female physicians making work-life balance a higher priority than male physicians, the study examines the survey data from 2014 to 2017, which features responses from 1,800 men and nearly 1,700 women. New York trains more resident physicians than any other state.

Starting compensation was defined as a combination of starting salary and any expected starting pay bonus. Measures of work-life balance were predictable nature of the workday, length of workday, frequency of overnight call duty, and frequency of weekend duty.

The research generated several key data points.

• From 1999 to 2017, mean starting compensation was $235,044 for men and $198,426 for women.
   
• Compared to men, women were more likely to rate control over all four measures of work-life balance as "very important." The difference ranged from 9 percentage points to 12 percentage points.
   
• When work-life balance and relationship and family factors were added to the New York survey in 2014, "salary differences changed only negligibly (less than $1,000)," the researchers wrote.
   
• Compared to men, women worked in primary care fields more often and surgical specialties less often.
   
• Choice of specialty played a major role in salary differences from 1999 to 2017, the researchers wrote. "Specialty consistently explained 40% to 55% of the total starting salary differences, with a mean share over the entire period of 46%."
   
• Other significant factors in determining salary differences were all in single-digit percentages. After choice of specialty, time spent in patient care was the second most significant factor, explaining 7% of the starting salary difference from 1999 to 2017.

Interpreting the data

The study indicates that work-life balance preferences have little impact on the gender pay gap between male and female physicians, the researchers wrote.

"Approximately 60 percent of the unadjusted gap in starting salary could be explained by observable characteristics—primarily specialty and hours spent in patient care. However, our analysis showed that physician-stated preferences for controlling work-life balance, including having predictable hours, the length of the workday, the frequency of being on call overnight, and the frequency of weekend duty, had virtually no effect on the starting salary differential between men and women."

To address the gender pay gap, the researchers call for more transparency in physician compensation.

"For example, if greater on-call responsibilities are associated with higher pay, making that expectation transparent and quantifiable is essential for the functioning of physician labor markets. Additionally, residency programs can play an important role in both setting expectations for graduating residents and disseminating information to aid and educate them about salary negotiations. If pay differences are the result of conscious choices, let them at least be well-informed choices," they wrote.