5 Reasons Women Doctors Earn Less Than Men

The physician gender pay gap is real, it's persistent, and it occurs across all medical specialties. The causes are complex, which makes finding solutions difficult.

A recent survey showing that male physicians in Maryland earn about 50% more in annual compensation than their female peers came as no surprise to Theresa Rohr-Kirchgraber, MD.

"Women physicians earn less than male physicians in almost every specialty and this is not new," says Rohr-Kirchgraber, executive director of the Indiana University National Center of Excellence in Women's Health, and a professor of clinical care and pediatrics.

She has been studying and speaking on gender pay inequities for years, and says that while the phenomenon is real, it defies an easy explanation.

In an email exchange with HealthLeaders, Rohr-Kirchgraber offered five reasons why the gap exists:

1. "Women physicians feel an additional burden when seeing patients and typically will feel as if we can never quite do enough," she says. "Therefore we may not bill at the level we should. We worry about the effect of the bill on the patient and then bill at lower levels."
    
2. "Even if the initial salary is the same as men, we are, in general, poor negotiators and may not negotiate up front for things that would improve our practice capability," she says. "For example, we had two researchers who came in on the same salary, one negotiated for larger research lab space and research techs, while the other did not. Guess who was further along in their career after 10 years?"
    
3. "The practice of medicine is not just about salary but about support. For example, if I only have one medical office assistant working with me, my patients wait longer and my turnaround times are longer," she says. "Most of our male physicians have a 'chaperone' in the room with them who can then help to speed things up especially with paps and pelvics."
    
4. "Women and underrepresented minorities score lower on patient satisfaction scores. For many of us, the patient satisfaction scores are a component of our reimbursement for salary," she says. "So, just being a woman, my scores will be lower, and I will make less at the end of the year. The assumption is not that we are worse physicians, but that the expectation is higher for us."
    
5. "We don't negotiate for higher salaries when it is time to re up," she says. "We think too much about what we did not do, or how we have come up short in our own expectations, and don't realize that each time our contract comes up for renewal we should discuss an increase in our salary and a consideration for other aspects of our income."
   
   "For example, we just started an 'Affinity group' at Indiana University Health, which is supposed to improve our physician engagement. Women like community and we are encouraged to join. But we currently have no remuneration for such activities. If we join, it takes away from our clinical practice."

The takeaway, Rohr-Kirchgraber says, is that women physicians need to bill and code in a way that better reflects the services they provide, must demand more more transparency in the workplace around salaries, and push to remove patient satisfaction scores as a factor in salary determinations.