Transparency is key to pay parity

Pay parity for women in healthcare is an old problem that in many ways has worsened over time.

Bias, a lack of transparency, pay models that value male work patterns and, more recently, the pandemic’s toll, mean women physicians still earn 72 cents on the dollar compared with their male peers. And that gap has widened during the past five years.

That variance is very noticeable among physicians, 70% of whom are now employed by hospitals or corporations. Last year, the difference between what men and women physicians earned was 28.2%, amounting to over $122,000, according to Doximity’s 2021 Physician Compensation Report.

“This does not seem prudent for the future success and growth of our field,” said Dr. Amy Gottlieb, chief faculty development officer at Baystate Health. “In addition to being not ideal ethically, it’s not a very sound business practice. We need to be paying folks equitably and fairly in order to encourage them to be members of our workforces.”

The issue simply hasn’t held the attention of those who “control the purse strings,” said Dr. Anupam Jena, healthcare policy professor at Harvard Medical School.

Jena and a number of other industry experts discussed some the largest roadblocks to gender pay parity and ways organizations are finding solutions through compensation standards and salary transparency.

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A she-cession

The pandemic has disproportionately impacted women in medicine whose responsibilities have ballooned as they juggle domestic duties, including childcare and remote schooling, as well as their jobs as physicians.

Female doctors are more likely to be in a household where both parties are physicians, and report spending more time on household tasks than their male counterparts, Jena said.

Workers who are underemployed or unemployed during an economic downturn experience persistent earnings losses, Gottlieb said.

But there’s a more pervasive issue: Women leaving the healthcare industry during the pandemic are often reacting to an inhospitable environment, said Dr. Vineet Arora, dean of medical education at the University of Chicago Pritzker School of Medicine.

A recent analysis of electronic health record data reveals that women actually spent more time with their patients than men—more time per visit, per day and per year. Because men and women are more likely to communicate with female physicians, said Dr. Ishani Ganguli, assistant professor of medicine at Harvard Medical School, women also spend more time answering patient messages.

As a result, fee-for-service models can inadvertently favor male physicians, she said.

“Medicine’s traditional way of valuing contributions and determining pay rewards the way male physicians have worked and lived for generations,” Gottlieb said. “Compensation methodology is really a crucible for all the forces that diminish women’s professional value within our institutions.”

A report co-authored by Gottlieb that analyzed 24 million primary-care visits nationwide found that women made 11% less than men annually because they had 11% fewer visits than men—mainly because the women were spending more time with their patients.

In general, there is a lot of implicit and unconscious bias still ingrained in healthcare, which means leaders often value a male physician’s performance over that of a woman’s, Arora said.

“Being male carries with it more connotations of leadership, more connotations of somebody who’s committed to their career,” she said.

Transparency and salary standards

The best way to close the gender pay gap is being transparent about worker salaries and implementing standard pay, Jena said, though most institutions are not being measured on this issue.

Conducting regular salary audits can identify where along the career continuum gender pay gaps are the most significant, allowing organizations to focus on the compensation methodologies used at initial hire, promotions and other junctures, Gottlieb said.

Salary audits can take a lot of time and resources to collect, organize and review the data, she said.

While the National Labor Relations Act allows employees to discuss and compare their salaries, many healthcare organizations still consider the practice taboo and do not openly disclose employee pay, said Dr. Roberta Gebhard, governance chair for the American Medical Women’s Association and founder of its gender equity task force.

Even though an institution’s base salary may appear to be equal, bonuses, promotions and the various pay structures used to compensate physicians in different locations and specialties often are not, she said.

Also, if a new hire negotiates a higher salary than comparable employees, then everyone’s salary should be increased, Gebhard said.

By the numbers

All physician specialties had gender pay gaps over 10% in 2021, except pediatric rheumatology, which had a gap of 7.8%, according to the Doximity report. On average, men earned $435,315 and women earned $312,571.

The gender pay gap was 9.6% for nurse practitioners, or around $12,292, and 11% for physician assistants, or about $14,646.

No matter how many variables researchers account for, including physicians’ geography, age, revenue and clinical productivity, the gap persists, said Dr. Natalia Birgisson, director of strategy for Doximity, which provides a salary map.

Using earnings data from 80,342 full-time U.S. physicians, researchers found that during a simulated 40-year career, male physicians earned an average income of $8,307,327 compared with $6,263,446 for female physicians—a gap of around $2 million, according to a December 2021 study published in Health Affairs.

Surgical specialists had the largest gender difference in career earnings at $2.5 million, followed by nonsurgical specialists with a $1.6 million difference and primary-care physicians with a $900,000 difference.

Seeking solutions

Founded in 2019, the not-for-profit Women in Medicine is focused on professional development and addressing gender pay parity through education, thought leadership, mentorship and community building.

“We’re teaching women how to disrupt the systems in which they work to not only improve their own situation, but also improve the situations for others,” said Dr. Shikha Jain, the organization’s founder and chair.

The group counsels members on how to negotiate salaries and plan career trajectories and also provides longitudinal leadership programs and mentorship and sponsorship opportunities. A separate program exists for men to help them become better allies to women leaders.

“In order for real systemic change to happen, we need those male leaders at the table, identifying those problems, making the changes internally and then advocating for those changes,” Jain said.

The organization is attempting to break out of healthcare silos and learn best practices from other industries that have found ways to solve gender pay inequity.

Equity in action

At the Medical College of Wisconsin, leaders use a statistical methodology to ensure that everyone is paid equitably based on experience, performance and responsibility that are aligned with compensation benchmarks.

For over a decade, the college has been working toward gender pay parity, conducting an annual compliance report and fair market value analysis, getting human resource support with new hires, holding budget discussions with the dean’s office, and implementing corrective actions that have been thoroughly reviewed, said Kevin Eide, associate vice president of total rewards and HR analytics at the medical school.

More than 1,600 employees were included in the college’s most recent review of pay parity and less than 3% were flagged for any compensation difference, Eide said.

Of the 43 individuals whose pay was reviewed, only 16 ended up requiring action on salary, he said.

The organization uses fair market value benchmarks and provides raises based on employees’ clinical productivity, value-based work effort and research or teaching work.

Every part of the compensation process, whether it involves hiring, bonuses, a change in status or annual increases, is reviewed for approval by the institutional compensation committee as well, Eide said.

“We want to engage at the time the decision is made, not try to review it a year later and then fix it,” he said.

Each year the college works with its departments, offering guidance and recommendations to help set their budgets in alignment with its equity principles.

The college shares the pay parity data with its chairs and a group called Advancing Women in Science and Medicine, Eide said. The institution’s employee website discloses how its salary benchmarking process works.

Eide said that while health systems will always run into problems figuring out how funding flows to various specialties and navigating the differences between academic medical centers and not-for-profits, operating with as much transparency as possible is a solid starting place.

Organizations should engage employees in fixing the problems, make sure to use clean data that takes into account individuals’ rank, specialty, merit and years worked.

In learning how to do this work, health systems can also look to each other for guidance and example, Eide said.

While more work is being done on these issues, it’s never really over, he said. “You need to build this into your process, do it constantly, every year, make it part of your culture. I think that’s the key to being successful.”

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