Physician Compensation: Gender Gap Persists, Some Trends Change

By Debra Wood, RN, contributor

September 9, 2013 - Despite an increase in the number of women physicians, they earn on average significantly less than their male colleagues--a physician gender gap that has persisted for two decades, according to a new study published as a research letter in JAMA Internal Medicine.

Anupam Jena: A physician gender gap exists regarding physician compensation.
Anupam B. Jena, MD, PhD, reported a gender pay gap for women physicians in a recent JAMA Internal Medicine study.

“The pay gap has been constant over the last 20 years, and we were shocked by that,” said co-author Anupam B. Jena, MD, PhD, at the department of health care policy at Harvard Medical School in Boston. “In the rest of the economy and overall market sector, we have seen declines in the male–female pay gap, rather considerable, and we expected the same trends to translate into the physician workforce.”

Yet the researchers found no statistically significant improvement over time in the earnings of female physicians relative to male physicians, with the male–female earnings gap at 25.3 percent in 2006-2010, or $56,000 annually. 

The research team, led by Seth A. Seabury, PhD, of the University of Southern California in Los Angeles, used nationally representative data from the March Current Population Survey (CPS) from 1987 to 2010. The sample included 1.3 million individuals, including 6,258 physicians and 31,857 other healthcare professionals. The researchers adjusted for hours worked. The data did not include information about specialty.

The percentage of female physicians surveyed increased from 10.3 percent in 1987-1990 to 28.4 percent in 2006-2010.

“We thought that shift to a large number of females in the physician workforce would have translated into a decrease in the wage gap,” Jena said. However, that did not happen.

During the study period, the gender pay gap decreased outside of healthcare, from 28.3 percent to 15.4 percent, with only a couple of bright spots within the industry. The gender pay gap decreased for registered nurses, from 10.7 percent in 1987-1990 to 5.6 percent in 2006-2010, and healthcare and insurance executives, which declined from 34.4 percent in 1987-1990 to 19.9 percent in the most recent period.

“If you put all of the fields together, you would find a statistically significant decline [in the gender pay gap] over the study periods,” Jena said.

In an accompanying editorial, Molly Cook, MD, a professor of medicine in the department of medicine and global health sciences at the University of California, San Francisco, offered some potential explanations for the physician gender pay gap. Women are more likely to work part-time, or, when working full-time, put in fewer hours than men, for which the study team had controlled. Another factor relates to specialties women pursue, but she said, “There is evidence that a preference for different specialties does not account for the earnings gap.”

Jena indicated that differences may exist in access to opportunities, such as higher-paying specialties.

“There may be an implicated bias against hiring women, because there are concerns about childrearing and taking time off,” Jena said. “Or it may be a matter of choice. It could be female physicians more than male physicians are lifestyle-oriented and as a result trade off higher-income opportunities with those that favor the lifestyle more. Distinguishing between those two things is difficult.”

Further research into the disparities might include sending résumés from male and female candidates with similar qualifications to potential employers to figure out the difference in responses. Jena questioned whether employers offer women less money than men or do not consider them for higher-paying positions.

Phil Miller: Merritt Hawkins has not noted a physician gender gap regarding pay.
Phil Miller said he has not witnessed employer bias toward hiring or paying women physicians, yet other changes were noted in the recent Merritt Hawkins survey.

Phil Miller, vice president of communications for the physician search and staffing firms Merritt Hawkins and Staff Care, companies of AMN Healthcare, reported that his organization has not seen health systems or large practice groups offer women physicians less money, and the employers appear equally happy with female and male candidates.

“If you have a full-time position available, we don’t see female doctors offered less than male doctors,” Miller said. “Particularly in primary care, where the need is, people are happy to recruit and pay female physicians.”

Merritt Hawkins recently released its “2013 Review of Physician and Advanced Practitioner Recruiting Incentives,” marking the 20th edition of the survey. This year’s survey tracks the 3,097 recruiting assignments the firm conducted from April 1, 2012, to March 31, 2013.

“For the most part we saw a continuation of trends that have been apparent for the last couple of years, but there were a few new wrinkles,” Miller said.

For the seventh year in a row, Merritt Hawkins conducted more search assignments for family physicians than for any other type of doctor. General internal medicine physicians were second on the list, also for the seventh year in a row. A few specialties lost income but most did not. Merritt Hawkins did not compare compensation by gender.

However, for the first time in 20 years, neither radiology nor anesthesiology made the list of the top 20 specialties in demand. Radiology has been hit with reimbursement cuts and reduced utilization. Anesthesia also has experienced declines in elective procedures, and certified registered nurse anesthetists (CRNAs) now provide 65 percent of the anesthesia, taking up some of the open positions.

Geriatric specialists made the top 20 list for the first time, as did nurse practitioners and physician assistants.

Miller expected the demand for primary care physicians and physician extenders is related to health systems and large groups putting together primary care networks that will allow them to take care of populations, such as in an accountable care organization (ACO).

“They cannot find the doctors they need, so they supplement them with NPs and PAs,” Miller said. “And it is more accepted that they are part of the healthcare team. There is an emphasis on everybody on the team working to the limits of their training.”

Additionally, the Merritt Hawkins survey confirmed that compensation programs are moving away from rewarding physicians for the volume of services they provide and toward rewarding them for the value of services they provide. In 2011, fewer than 7 percent of Merritt Hawkins’ recruiting assignments offered physicians a production bonus that included payments based on quality of care metrics, but this year that number increased to 39 percent.

“People are experimenting with different compensation models,” Miller said.

Health systems also are reaching out into the community with urgent care centers, retail clinics and freestanding emergency departments. Many of these primary care physician opportunities offer regular hours, but they also pay slightly less.

Search assignments also have shifted from largely smaller communities to urban areas.

“Now the need is so great, even urban-based and name-brand facilities are using us,” Miller said. “It illustrates the [physician] shortage is no longer a regional problem.”

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