Why We Need To Talk About The Gender Pay Gap In Medicine
If you were a girl who dreamt of being a doctor and saving lives, or working in medical research to find the cure for cancer, the data on gender inequality in medicine isn't necessarily supporting that dream. A new study from Massachusetts found that in the academic world, medical cardiology professionals who are female are less likely to be full professors; and that joins an entire collection of stats that show that to be a female in the medical field is to be underpaid, under-promoted, and often targeted by gender concerns. (It's not just in America, either; as of 2015, for example, there was only one woman councilor in the entire Japanese Surgical Society.) And no, it's not able to be explained by factors like "taking time off to have babies."
Doctoring in the Western world has had a strange history, in terms of gender. The notion of nursing others has often been seen as inherently female, which often created the possibility for women with medical ambitions to get access to the field; but the work of doctoring itself, from diagnosis to surgery, has been hugely male. For every Florence Nightingale, who managed to significantly shift the field of medicine through genius and force of personality, there have been countless others whose potential medical gifts were stymied by gender traditions. (Dr. James Barry, a brilliant Irish army surgeon, famously concealed her gender for most of her life to be able to rise through the medical ranks in the 19th century.)
While female access to medical practice is now hugely expanded, problems clearly remain, with unfortunate consequences for a whole bunch of issues. Here's why the gender pay gap in medicine matters.
The Gender Pay Gap In Medicine Is Huge
A study in 2016 made a major splash when it looked at the precise pay disparity between male and female doctors in 12 states across America, and found a whopping average gap between the genders — $50,000, to be exact. Even when the findings were adjusted to take into account the doctors' ages, years of experience, published papers and receipt of awards and grants, a $20,000 pay gap persisted. Only one specialty, radiology, had no real pay gap, perhaps because "radio technician" is seen more as a female nurse-equivalent role. The scientists tried to figure out what was happening, and suggest it might be partially a gendered-expectation problem: female doctors are less likely to ask for raises or get competitive while job-seeking, for instance. And because we celebrate aggression, they get penalized for it. On top of that, they said, gender discrimination was definitely playing a nasty role.
Exploring what's actually happening here is an intriguing and frustrating thing. A study on the earnings of male and female medical professionals between 1987 and 2010 found that the gender gap is getting better, but is still pretty ridiculous: for physicians, amounted to about 25 percent in the period of 2006-2010. And that was after they'd adjusted for working hours because female medics may work less due to childcare obligations. On top of overt discrimination, the researchers pointed out, there could be more subtle gender problems at play. "A preference of female physicians for lower-paying specialties (eg, pediatrics or primary care)," which are seen as "women's work" and therefore attract less money, or "reduced opportunity to enter higher paying specialities" even if they wanted to, are both suggested as explanations. How we view different medical fields and the gender of "care," in other words, is affecting where women with medical talent end up and how they get paid.
Even if they do go into the highest-paid areas, though, they still don't earn as much. A 2016 study of neurologists, a very lucrative area of medicine, found that the more they earned, the more the gay gap enlarged (to over $100,000 among the biggest stars). No matter how high we rise, we're penalized.
The Gap Discourages Women From Being Doctors
The earnings gap does matter, not just because of your sense of fairness, but for the sake of women entering medicine at all. Medical school in America is cripplingly expensive and raises huge amounts of debt for most people seeking to study it. And that raises the question: was it worth it?
A study in 2012 found, depressingly, that women who'd spent their money on higher doctoring degrees were facing such an earnings gap that they'd have been better off financially if they'd studied to be a physician's assistant instead. As far as discouragement for being a doctor goes, you can't do worse than that: stick to a lower-skill degree, or risk debt and problems by trying to be a fancy doctor.
The Gap Cripples Promotions & Publications
Medicine isn't all about active doctoring; medical academics are also a huge part of the ecosystem, performing experiments and finding new science about diseases and the human body that furthers medicine every day. And when it comes to that particular world, female contributions are regularly and grossly undervalued, which is both infuriating and a massive loss to medical science in general.
A 2000 study of data up to 1993 found that women are often fast to reach the lower rungs of academic medicine, but then very slow to be promoted to professorships or senior positions after that, even though their numbers were gradually swelling in medical school in general.
In 2014, one scientist tried to lock down why, and came up with a few ideas: beyond outright discrimination, women are still expected to do the bulk of childcare duties, and so tend to opt for medical areas that allow flexible hours, which often draws them away from the research-heavy kinds of jobs that produce Big Results and make professors. Female academics often also have a mentoring problem, in that they don't have any — which hobbles their ability to get solid connections that bolster research teams and create future interesting ideas. Gender expectations, discrimination, and the need to soldier on alone are all hampering women's abilities to find the cure for cancer.
Women May Actually Be Better Doctors
This entire mess is exacerbated by the increasing evidence that, in certain ways particularly to do with in-person patient care, female physicians actually do better than male ones. Yep: female doctors are better doctors and actually get paid less for it.
The data that supports this is pretty compelling. The most famous recent bit of science dates from 2016, when Harvard researchers looked at the hospital visits of over a million elderly Medicare patients and how they fared 30 days after their initial visit. Their rates of survival and readmission were significantly lower if they'd been seen by a female physician. Why? Because, it seems, female physicians did more communicating with their elderly patients, focused on preventative care, and spent more time one-on-one. The difference was whopping enough, the scientists noted, that if male researchers had the same standard of care, 32,000 more elderly people would survive in America every year.
It's not all centered on elderly emergency visits, either. Female physicians are more likely to refer their patients for breast cancer screenings and Pap smears, are more able to diagnose acute coronary syndrome from ECGs, and spent on average 2.24 minutes longer in every consultation than males. And it seems that patients also respond better to female physicians. A review of studies from 2002 found that "patients spoke more to female physicians than to male physicians, disclosed more biomedical and psychosocial information, and made more positive statements to female physicians," though they also interrupted them more. That sort of relationship can help make better medical outcomes across the board.
If you're underpaying, under-promoting, and under-appreciating women in medicine, you're harming a resource that has been statistically shown to be better than the alternative in several extremely important aspects.