A study finds a "significant gender gap" in starting salaries, by gender, of physicians leaving residency programs in New York State between 1999-2008. But researchers writing in Health Affairs say this is an unexplained trend that seems to be growing over time, and needs to be further studied.
Within a decade, male physicians leaving residency programs were consistently and increasingly paid more than women, 17% more in 2008, reflecting significant gender pay gaps, according to a Health Affairs study released Thursday.
On the face of it, just looking at the numbers, it seems, either blatantly sexist or the result of gender discrimination. Not so fast, say the authors. There may have been other reasons intrinsically involved, such as women who wanted special working arrangements, or had different lifestyle goals, such as related to child rearing. Or, they may have had different negotiation styles or agreements that set the stage for the salary levels.
Or it may be the result of all of the above, because, as far as authors of the study are concerned, their findings are simply inexplicable, or in their words, "unexplained."
In examining starting salaries by gender of physicians leaving residency programs in New York state during 1999-2008, the researchers found a "significant gender gap" that they say cannot specifically be explained by specialty choice, practice setting, work hours or other characteristics. That flies in the face, generally, of previous research that shows gender differences can specifically be accounted for by a tendency of women to go into primary care, take time off for children, or cut back hours, they say.
The gap, they say, existed throughout the ten-year survey period. According to their figures, in 2008, male physicians newly trained in New York made on an average $16,819 more than newly trained female physicians, compared to the $3,600 in 1999.
"The power of physicians' observable characteristics – such as gender and specialty choices – to explain the differences in salaries diminished over time, which has created a widening unexplained starting salary gap between male and female physicians in recent years," authors wrote in the study.
"I was surprised by our findings, in particular by the widening, rather than shrinking gap in time," Susan E. Gerber, MD, an assistant professor in the Department of Obstetrics and Gynecology, Northwestern University in Chicago, and one of the co-authors of the study, told me.
"In all likelihood," she adds, "This is a multi-factorial phenomenon. While it is unclear why it would be on the rise, we cannot exclude the possibility that gender discrimination plays a role."
Tony Lo Sasso, a professor and senior research scientist in the health policy and administration division, for the school of public health, University of Illinois at Chicago, another co-author, tells me while gender discrimination is a possibility, "it doesn't ring true," because there is too much room for other, unexplained probabilities, such as specific work arrangements, for the reduced salaries for women.
"We should be cautious in trying to ascribe explanations which are essentially unobservable things, not observed by us," Lo Sasso says.
Lo Sasso and Gerber agree that many variables are involved, such as specific work-life arrangements among men and women, and lifestyle choices, generally, that go into the mix of what occurs on pay day for work and family balance. In some ways, they are living it. They are married.
Gerber says there are areas in their study's data collection that did not account for all the subtleties in physician practice styles that could account for some of the salary differences, and hence, she says, there is need for further study. For instance, "on call" preferences may not have been picked up (in their study) and are likely reflected in compensation imbalance," she says.
There are also other reasons for the pay differences that could simply be the result of negotiations between physicians and their office management. "Newly trained physicians typically have no experience in contract negotiation, and it is possible that there is a gender disparity," Gerber says.
Still, she notes: "I cannot explain why that would have increased over time."
Gender gaps exist through a wide variety of settings, and there is a "wide spectrum of individual preference in changes in workplace settings or environment," Lo Sasso says.
In looking at their data, Lo Sasso and Gerber and their other co-authors note that other previous studies have been inconclusive about pay difference reasons, and "no clear conclusion on this issue has been reached."
New York State is home to more residency programs and more resident physicians than any other state. The sample included 4,918 men and 3,315 women, and more than 62% of physicians responded.
The salary discrepancies were revealed somewhat in the study and survey respondents. There were more women who planned to devote fewer than 40 hours per week to patient care, and a lower proportion of women who planned to devote more than 50 hours per week to patient care. Women also had a larger representation than men in lower-paying specialties, for instance, 13.9 percent of women were in pediatrics, versus 5 % of the men. Women also had lower average starting salaries than mean for nearly all specialties
As they began their study, the authors thought an explanation for the pay differences could be the increased number of women in primary care practice. However, while the number of female physicians in primary care has indeed been rising, they say, there have been proportionately a decreasing percentage of female physicians having chosen to enter primary care fields.
The study did not include possible scenarios that could reveal more of the differences in salaries. For instance, the study did not include the questioning of respondents about marital and family status.
Indeed, Lo Sasso says, the survey findings may come down to "women making these tradeoffs, willing to give up the less tangible aspects" of physician work, such as salary, for a work-life balance.
Maybe. But maybe not so fast, according to his wife.
"There are certainly demographic changes that affect career choices, and younger generations have different goals as far as a work life/home life balance," says Gerber.
"However, most other studies have demonstrated a similar impact of this demographic shift on both genders rather than on just women," she adds. "Both male and female trainees are increasingly likely to seek employment opportunities with flexibility in scheduling, as opposed to the old 'solo practice' model," she says, noting her experience in the practice of obstetrics and gynecology.
Regardless, there has to be further, detailed study into what they have begun to find, the authors say, opening the door for "new considerations for medical institutions and policy makers."
Future research would benefit from a "more detailed understanding of the specific job characteristics," Gerber says. In that way, it could be determined whether "this compensation disparity truly reflects differences in the jobs themselves, or other forces at play in the labor market."
In the wake of healthcare reform, it is more important than ever to know more about the physician labor force, says Lo Sasso, not only for physicians themselves, but overall patient care.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
