The gender pay gap in the upper echelons of the healthcare industry is mirrored by the associations that support it.
The latest example of this can be seen in the American Medical Association's recently released tax form, which covers calendar 2018. The trade group's 25-person senior leadership team is almost evenly split between men and women. Of those, only three of the nine highest-paid executives listed on the tax form were women. They made an average of about $888,000 in total compensation last year.
The six highest-paid men at the AMA made an average of $1.3 million. That includes the CEO, Dr. James Madara, who received $2.5 million in total compensation last year, up from $2.2 million in 2017.
C-suite executives like Madara and the AMA's former chief operating officer, Bernard Hengesbaugh, skew the numbers because they're paid more than senior vice presidents, said AMA spokesman Robert Mills.
"There is high competition for those positions," he said. "The value of a senior executive at a C-suite level is reflected in what the market typically pays for these individuals."
Associations often take on issues of equality very publicly. In fact, the AMA in 2018 received attention when its House of Delegates adopted multiple resolutions to advocate for policies to close the pay gap between male and female physicians.
Men make about 20% more than women across the companies Korn Ferry has studied, but that's mostly because they tend to dominate the highest positions, said Tom McMullen, a senior client partner with the firm.
"It's really getting more females into that top job is where the real opportunity is," he said. "I characterize this not as much of a pay issue, but a talent acquisition issue, a leadership development issue, a succession planning issue. So, more broader talent management issues for companies than pay issues."
The AMA isn't unique in its pay gap at the top level. The highest paid male executives in comparable positions at the American Hospital Association made $1.5 million in total compensation on average last year compared with $753,000 for the highest paid female executives, according to its tax form. An AHA spokesperson said in a statement that the organization uses a rigorous process to determine compensation that includes an annual review by an independent consultant.
At the Federation of American Hospitals, top male executives' total compensation averaged $1.5 million last year, compared with about $544,000 for top female executives. The organization did not respond to a request for comment.
Results at all three organizations were skewed by high-paid male CEOs.
The gender pay gap was smaller at America's Health Insurance Plans. There, top female executives' total compensation was about $414,000 on average last year, and their male counterparts made about $467,000 on average. The analysis excluded incoming and outgoing CEOs. CEO Matt Eyles said in a statement that the organization depends on diversity among its leaders to ensure it's creating solutions for people from different communities, experiences and walks of life.
The pay gap becomes smaller when comparing people in similar positions, McMullen said. The AMA's two female senior vice presidents last year averaged $967,000 in total compensation, surpassing its three male senior vice presidents, who averaged $950,000.
If nothing else, pay studies demonstrate the need to take a fresh look at how organizations decide who becomes CEO, McMullen said.
"Do we have an adequate pipeline of diverse candidates? A lot of times the answer is historically, 'no,'" he said. "A lot of times males go into it because there hasn't been an adequate pipeline of diverse talent."
It might not be surprising that pay practices at healthcare associations reflect the industry they serve. All 25 executives on Modern Healthcare's latest top 25 highest-paid not-for-profit health system executives list were men. The first woman didn't show up until No. 33.
Healthcare saw the biggest gender pay gap of any industry at the C-suite level, including CEO, CFO, human resources chief and general counsel, according to a 2018 analysis from the compensation benchmarking firm Equilar.
"Men earned exceptionally more than women across all executive positions in the healthcare sector," the report said.
Male healthcare CFOs, for example, made $1.55 for every $1 that female CFOs made in 2017, the report found. Male healthcare CEOs made $1.51 for every $1 female CEOs made that year; the same was true for human resource chiefs.
The disparity also exists in the provider world, where male physicians earn an average of $1.25 for every $1 female doctors make, according to a report from Doximity.
It's hard to find companies in any industry that don't have gender pay gaps, said Kellie McElhaney, founder of the Center for Equity, Gender And Leadership at the University of California at Berkeley.
Clothing retailer Gap, Inc. had a 0% gap when McElhaney and a colleague studied the company in 2017. But at that time, women comprised 78% of the company's executive team. Its founders, a husband and wife, contributed equal amounts of cash and held equal control over the company. Gap also hired an outside analytics firm to perform its pay analysis, which McElhaney recommends companies do in lieu of analyzing the data internally.
Gender pay analyses oftentimes don't incorporate race, McElhaney said. While white women currently make about 80 cents for every dollar white men make, black women make 63 cents and Latina women make 54 cents.
"I think we have done women of color a disservice by contextualizing this and studying it and researching it as a white women's challenge, when in fact theirs is much bigger," she said.
The AMA's selection of Dr. Susan Bailey as its president-elect in June means it will have three consecutive female presidents for the first time in the organization's history. In a September interview with Modern Healthcare, current AMA President Dr. Patrice Harris said the gender composition of the AMA's leadership continues to evolve to better reflect medical students training today.
"Although we are representative of that, we are not by any means where we need to be and we need to make sure that there are continuous opportunities for women in leadership," she said. "But I think we will use this year and this opportunity to highlight accomplishments and to be tangible evidence that a woman can aspire to leadership."
Female members of the AMA's Board of Trustees earned more than their male peers last year. The six female trustees listed on the tax form made an average of nearly $125,000, compared with $109,000 among the 18 male trustees. The includes the AMA's immediate past President, Dr. Barbara McAneny, who became the AMA's president in June 2018 and received $287,000 in total compensation from the organization last year. The AMA paid her predecessor, Dr. David Barbe, about $292,000 in total compensation before he stepped down in June 2018.
Harris made $222,080 in total compensation from the AMA while serving as president-elect in 2018.
Being a member of the AMA's board is a much bigger job than it is at other associations, a difference that's reflected in their higher compensation relative to other boards, Mills said.
"The other presidents and senior members of the board also spend a significant amount of time fulfilling their duties representing the AMA around the country," he said.