Data shows that women physicians make about $20,000 a year less than their male counterparts. But there's no data—yet—that shows how much of wage discrimination is intentional.
Women graduate from colleges and universities at higher rates than men. Three current supreme court judges are women. The presumptive Democratic presidential nominee is a woman.
But despite these chipper talking points, the evidence is clear: We still have a long journey ahead of us before we reach gender equality and income disparities are still very real.
And healthcare is no different than other fields, a recent study published in JAMA Internal Medicine illustrates.
Anupam B. Jena, MD, the study's lead author, spoke with me recently about the findings. He is associate professor of healthcare policy. The transcript below has been lightly edited.
HLM: Tell about your study and what you were trying to find out.
Jena: A number of studies both inside and outside of healthcare have found wage disparities between men and women for decades now. One of the questions that constantly comes up is whether or not the research is able to count all of the factors that we know impact income.
HLM: Tell about the data used in the study.
Jena: We had really unique data from two sources. We assembled data from 24 medical schools in 12 states.
These states have laws that require state employees' wages to be reported online, so we were able to create a database of physicians at state medical schools with their actual salaries.
We linked that data to information from a comprehensive physician database assembling data on a whole host of characteristics, including experience, specialty, where they trained, how many publications they've authored, how many grants they have, and how many clinical trials they've run.
We also obtained information that is publically available from Medicare on clinical reimbursements. So, we had detailed information on physician salaries and a lot of measures of research and clinical activity that we could merge together.
All told, we looked at about 10,000 physicians, and we found that women earn about 8% less than men.
HLM: Can you put that into perspective?
Jena: The difference in earnings comes out to about $20,000 annually, which is quite a bit of money.
HLM: Were you able to normalize the data to identify the factors that are creating the disparity?
Jena: Something commonly cited in similar studies is that women are more likely to work part time, and as a result, their annual salaries are expected to be lower.
But we accounted for that in two different ways; first, by looking at how much clinical revenue a person brings in from Medicare, which is a strong indicator of how active they are.
Second, we focused on physicians who have NIH grants. [Those physicians] are very unlikely to be part time. And we found the exact same results in that subgroup of men and women.
So, in my mind, these facts dispute any notion that the income gap is due to more women being part time workers.
HLM: How does discrimination happen? How much of it is intentional?
Jena: Our study didn't have any qualitative analysis, but I can speculate on why I think this is happening. The first conclusion is that women are less inclined toward negotiation or feel they have less negotiating power when it comes to salary setting.
The second is that women are less likely than men to solicit job offers and then use those offers as leverage with their employers to negotiate a higher wage.
Also, there is overt discrimination, which can be either conscious or subconscious.
A department chair might have a pot of money to allocate as raises, but if that's not done in a uniform way, there can be a subjective perception of a chair that one person is contributing more than another.
Worst case, it can be overt discrimination. I think that is less common than subjective-type discrimination, but it's hard to comment how often that actually happens. We don't have any data on it.
HLM: When hiring and giving out raises, what should HR leaders be mindful of?
Jena: I think that HR for any employer should have a solid understanding of the various ways an employee contributes to an institution.
If they can actually quantify their contributions, that's even better, because the quantification of those contributions is most likely to eliminate disparities.
Lena J. Weiner is an associate editor at HealthLeaders Media.