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Exploding Myths About Medicine’s Wage Gap: Lessons From the Past and Present

It’s not news that women are paid less than men for comparable work, subject to variation across race, field of labor, and other factors. In medicine, the gap is particularly pronounced.

At first glance, we wouldn’t necessarily expect medicine to be particularly inequitable. Being a physician is a high-status occupation that requires a great deal of education and pays high wages. Women are present in the field in large numbers. And, as historians have demonstrated, women’s involvement in the profession has a long and rich history.1 But despite these factors, the profession is today one of the most inequitable. There is also evidence suggesting that the gap has actually widened in recent years.

Commentators have suggested numerous explanations for medicine’s wage gap – which oftentimes boil down to attributing the gap to women’s own choices. Allegedly, women choose to go into lower-paying specialties and choose to work fewer hours than male colleagues. Most likely, women in medicine and others find comfort in the idea that inequalities can be explained by choice. Most recent research conducted on the subject, however, suggests that this explanation for medicine’s pay gap is a myth.

According to this line of argument, women are more likely to go into lower-paying fields, including pediatrics and family medicine. Of course, there are many questions that aren’t answered by this explanation. Why do women physicians choose lower-paying specializations? Why are these specializations lower-paying? Is it perhaps because of women’s prominence in these fields?

But that’s not the only problem with the specialization explanation. Recent research indicates that women receive less compensation for their work regardless of specialty. A study recently published in The American Journal of Medicine, authored by Lisa L. Willett and colleagues, demonstrates this point. Willett et al looked at Internal Medicine residency program directors across the United States, finding that women who hold this position generally make around $25,000 less than their male counterparts.

This corroborates prior studies, which suggest that gender-based salary disparities persist in academic medicine even when factors such as specialty and number of publications were accounted for. Within clinical medicine, there’s a similar story. Even when controlling for specialty and work time, there is still a pay gap. This suggests that it is not women’s choices or alleged lack of merit that hinder them, but institutionalized sexism. Even when a woman physician holds responsibilities that are identical to a male counterpart, her work is perceived as less valuable and receives less compensation.

Given this overwhelming body of evidence, it’s time that we stopped perpetuating the myth that women physicians get paid less because of their choice in specialty. It is clear that gender inequality needs to be addressed within all areas of specialization, at a systemic level. Indeed, other professions within medicine, such as nursing, also feature inequalities in pay that favor men.

For many people, including women, it may be more comforting to believe that disparities are the result of individual choices. We like to think that we, not unseen social forces, shape our own destinies. But this belief is not borne out by evidence.

Solving the problem requires recognition of its root causes. We need to acknowledge that society-wide sexism – in conjunction with racism, homophobia, and other social prejudices – have created long-lasting disparities.

This advertisement for Optical Scanning Corporation equipment disparaged women computer operators as inefficient and encouraged replacing them with new technology. (Source: "Researcher Reveals How "Computer Geeks" Replaced "Computer Girls," Gender News, 2011.)
This advertisement for Optical Scanning Corporation equipment disparaged women computer operators as inefficient and encouraged replacing them with new technology. (Source: “Researcher Reveals How “Computer Geeks” Replaced “Computer Girls,” Gender News, 2011.)

From a historical perspective, it is important to note that the progression of time has not led to progressively greater equity. While women physicians have increased in number and in prominence over the past decades, numerical representation is only part of the story.

There are historical parallels to be found in other professions. In the early nineteenth century, teaching was almost exclusively a profession for men, while many early computer programmers were women. Yet as the gender balance reversed in these fields, the pay and prestige accorded to the professions changed, too. Computer programming became a difficult task requiring male genius, while teaching came to be perceived as a “soft” and womanly occupation – hardly worth a high salary or social prestige.

Medicine, as a profession that still attracts many women and men, has not yet reached the point where the profession as a whole has declined in prestige due to women’s presence. Yet there is clearly much work to be done before medicine is truly equitable.

We cannot simply assume that women’s position in medicine will improve as their numbers increase, but rather must assume a pro-active role in addressing inequality.

Notes

  1. Regina Morantz-Sanchez, Sympathy and Science: Women Physicians in American Medicine (Chapel Hill: University of North Carolina Press, 2000 [1985]). Return to text.

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