The gender pay gap in medicine

Issue: BCMJ, vol. 63 , No. 3 , April 2021 , Pages 101 Editorials

Gender pay gaps continue to exist in a multitude of professions, and medicine is not immune, as highlighted by a recent CMAJ article by Drs Cohen and Kiran.[1] As a female physician and a new mother, I am particularly interested and intrigued in this topic. How can I explain to women who enter medicine in the future that they may be paid less despite doing the same work as men, solely because of their gender? The complexity of this issue and the solutions to it cannot be thoroughly discussed in a few short paragraphs, but I hope to encourage increased awareness and conversations on this topic.

More women are entering medicine than ever before. The entering class of UBC Medicine in 2016 was 53.8% women.[2] Despite this, implicit gender-based biases still existed throughout my medical school and residency training. I can’t count the number of times I have been mistaken for a nurse while the male colleague is assumed to be the doctor. Or how many times I have heard offhand comments about a female colleague who had to miss a day of work to take care of a sick child. Achieving a work-life balance is difficult, so it is not difficult to understand why female physicians may be drawn to certain specialties. Ultimately, we are all free to choose which specialty we pursue, but the gender pay gap is not explained only by the fact that female physicians may be more drawn to lower-paying specialties. The pay gap exists in higher-paying specialties as well.[1]

Neither can the gender pay gap be explained by the fact that women work fewer hours than men. This has been backed by studies where, despite adjusting for confounders such as the number of hours worked, age, or years in practice, male physicians still consistently earned more than female physicians.[3,4] A 2017 study in BC showed that female GPs made 36% less than male GPs, even though they worked only 3.2 fewer hours per week compared to male GPs.[5] Others have attributed the pay gap issue to female physicians spending more time with patients in general; therefore, in a fee-for-service model, they may be paid less than their male colleagues overall. But the pay gap exists in other payment models as well, such as in the UK where physicians are salaried.[6]

Current parental leave policies also make it difficult for women taking maternity leave to keep up with office expenses or career advancements, again contributing to the gender pay gap. Women may also spend more time caring for their children or doing household chores, leading to less time for clinical duties. Programs should be put in place to encourage male physicians to take paternity leave as well; the Doctors of BC Parental Leave Program is open to both male and female physicians, but more can still be done.

Solutions to close the gender pay gap are complex. It will require change at many levels. There are several suggestions by Drs Cohen and Kiran, at both the individual and system level, such as advocating for pay transparency, improving parental leave programs, and encouraging women to take on leadership roles in medicine. I have had many mentors who have shown me that there is nothing too great to achieve, but it starts with listening and perseverance. As more doors open for women in medicine, we should all strive for true equality.

Ultimately, the question we should each be asking ourselves is not whether a gender pay gap exists in medicine, but what can I do to help close it?
—Yvonne Sin, MD


References

1.    Cohen M, Kiran T. Closing the gender pay gap in Canadian medicine. CMAJ 2020;192:E1011-E1017.

2.    UBC Faculty of Medicine, MD Undergraduate Program. Statistical data on application and admissions – 2018 (Med 2022). Accessed 1 February 2020. https://mdprogram.med.ubc.ca/files/2018/10/MED-2022-Admissions-Statistics.pdf.

3.    Jagsi R, Griffith KA, Steward A, et al. Gender differences in the salaries of physician researchers. JAMA 2012;307:2410-2417.

4.    Apaydin EA, Chen PG, Friedberg MW. Differences in physician income by gender in a multiregion survey. J Gen Intern Med 2018;33:1574-1581.

5.    Hedden L, Barer ML, McGrail K, et al. In British Columbia, the supply of primary care physicians grew, but their rate of clinical activity declined. Health Aff (Millwood) 2017;36:1904-1911.

6.    Rimmer A. The gender pay gap: Female doctors still earn a third less than male doctors. BMJ 2017;357:j1967.

Yvonne Sin, MD. The gender pay gap in medicine. BCMJ, Vol. 63, No. 3, April, 2021, Page(s) 101 - Editorials.



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Rita McCracken says: reply

I appreciate Dr. Sin's call to action, " Ultimately, the question we should each be asking ourselves is not whether a gender pay gap exists in medicine, but what can I do to help close it? " And, I urge our professional representative body (Doctors of BC) and our main payer (BC Ministry of Health) to a) engage experts to do a review of processes and structures that are maintaining the gender pay gap, despite intentions to have it change and b) start to publicly report what this examination finds.

Brenda Hardie says: reply

Thank you Dr. Sin for this editorial, on this important topic. Studies show that women also have increased rates of burnout compared with male colleagues. The pandemic has had an extra toll on women, making all of this much worse.
You point out that there are some clear recommendations that have been made to work to close this gap. We know this is a complex issue that will take many nuanced changes, but a few broad strokes can happen now. Encouraging men to take parental leave is wonderfully achievable place to start, and is evidence-informed. Maybe we will see DoBC promote this more widely. DoBC could also be targeting and measuring its success in having women in leadership roles, and being transparent about what % of stipends goes to men vs women might be an enlightening project. The kind of encouragement needed for women to be in the places where decisions are made is often structural. This is not phoning, emailing, and telling them they would be great and should apply - not that kind of encouragement. We are talking about changing how we recruit, support and retain women in leadership through making gender equity a priority through tangible goals, metrics, and system improvements. This is negotiation time for the PMA and gender equity could be a value that is baked into the process. Imagine what we might achieve if this were the case!
I am excited that you have opened up this conversation in a meaningful way for DoBC and all of us in the province. I am looking forward to reading more articles on what we are doing, and how well we are making progress to reduce the gender pay gap. Thanks for taking this brave step, since we know you are likely to experience significant backlash as a result of speaking out for gender equity.

Mike Figurski MD says: reply

Thanks for the interesting perspective. Medicine in Canada is largely fee for service, and career paths are chosen with consideration of lifestyle and likely income. My own income has fluctated widely based on changing personal priorities, with the years of low income associated high personal enjoyment. Serious consideraton of gender income disparity should begin with an examination of those choices by both genders. Perhaps half the gender gap is because of poor choices men are compelled to make.

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