Researchers have found that the percentage of women in internal medicine specialties has decreased over the past two decades, which is likely contributing to the physician wage gender gap.
From 1991 to 2016, the percentage of women in internal medicine increased, but the percentage of women in subspecialty fellowships fell, recent research shows. The percentage of women enrolled in cardiovascular disease fellowships was particularly low.
An increasing number of women have been enrolling in medical schools, with women accounting for 50.7% of enrollees in 2017. However, female physicians have lagged behind their male counterparts in compensation.
The lead author of the recent research, which was published in the Journal of the American Medical Association, told HealthLeaders that the growing underrepresentation of women in internal medicine subspecialties is contributing to the compensation gap.
"The fewer women we have in the more highly reimbursed specialties of medicine, the wider the gender wage gap in medicine will be," said Mary Norine Walsh, MD, MACC, medical director of Heart Failure and Cardiac Transplantation at St. Vincent Heart Center in Indianapolis.
Walsh and her co-authors generated several key data points:
- From 1991 to 2016, the percentage of female internal medicine residents increased from 30.2% to 43.2%.
- In 1991, 33.3% of internal medicine subspecialty residents were women and 66.7% were men.
- In 2016, 23.6% of internal medicine subspecialty residents were women and 76.4% were men.
- The researchers examined data for nine subspecialties. Women represented 21.3% of cardiovascular disease fellows—the lowest representation of women in the nine subspecialties.
- Women were most highly represented in geriatric medicine, at 76.9%.
"Between 1991 and 2016, although the percentage of women in internal medicine residencies increased, the percentage of women in subspecialty fellowships decreased," Walsh and her co-authors wrote.
Interpreting the data
Female and male physicians have significantly different views of careers in cardiology, the co-authors wrote.
"A survey of internal medicine residents about their professional preferences, their perceptions of cardiology, and how these attitudes combine to inform career choices showed substantial sex differences. More women than men reported never considering cardiology, and women had different perceptions of cardiology than men. Women cardiologists are more likely than men to experience sex and parenting discrimination, be single, not have children, and report less satisfaction in family life, though overall career satisfaction remains high for both men and women," they wrote.
Differing career goals between women and men could be influencing the choice of specialty between the genders, Walsh told HealthLeaders. "When asked, women internal medicine residents have assigned a greater importance to long-term patient relationships and family time than to financial considerations."
A lack of female role models in cardiology could be contributing to underrepresentation of women in the field, she said. "Because of the fewer numbers of female cardiologists, female trainees aren't always exposed to female cardiologist role models during their training."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
From 1991 to 2016, the percentage of female internal medicine residents increased from 30.2% to 43.2%.
When researchers examined the percentage of women in nine internal medicine subspecialties, women accounted for only 21.3% of cardiovascular disease fellows.
Low representation of women in lucrative subspecialties such as cardiology is probably contributing to the gender wage gap among physicians.