Michigan Medicine is one of few institutions that has addressed pay inequity. Physician faculty members are paid a salary based on nationally competitive pay for their specialty. Further, all faculty members for that specialty are paid the same depending on their position as an assistant, associate or full professor. Uniform raises are given to staff annually.
Dr. Michael Mulholland, chair of the department of surgery at Michigan, said because compensation isn't an “issue of contention,” physicians are able to “use the energy for better purposes” like creative solutions and research.
The majority of hospitals don't pay doctors the way Michigan Medicine does. Instead, most are compensated based on services provided. Mulholland said this structure enables the pay gap because there is room for variability.
Pay inequities “can develop for millions of reasons, and they (hospitals) are likely just not paying attention or being mindful about what they are trying to achieve,” he said.
But compensation can be fair in the traditional pay structure, too. In the surgery department at the University of Alabama at Birmingham, which uses productivity and accomplishments to determine pay, a new compensation model resulted in a reduction—although not total elimination—of the pay gap. The model, which went into effect in January 2017, continues to compensate surgeons based on services but withholds 12.5% of that pay. For the amount withheld, 10% is divided and paid back to surgeons meeting productivity targets and the remaining 2.5% can be used to give incentives for academic activity or other projects.
The changes resulted in a significant rise in salary for female surgeons and decreased the pay gap. “If you make pay equitable and transparent, it has the capability to fix any gaps in pay based on gender, based on race,” said Dr. Herbert Chen, chairman of the department of surgery at UAB. Chen said he's seen increased interest from other institutions in developing similar compensation models.
Michigan Medicine also created a program last year called Michigan Promise to recruit and retain more women and minority surgeons. Leadership development is part of the effort as well.
During the hiring process, a panel of 15 faculty members of different genders and races interviews with candidates. “It's a nice way to make sure that everyone gets a fair shake,” said Dr. Dana Telem, an associate professor of general surgery at Michigan Medicine who helped develop the program.
Michigan Medicine has also implemented leadership development programs, limited meetings after 5 p.m. and mandated departmentwide gender bias and awareness training.
Telem said benchmarks include how many women and minority surgeons are hired and promoted to leadership positions in the next few years.
Lemak, who worked at Michigan Medicine, said the institution “is an outlier” in terms of how intentional and deliberately they're addressing the issue.