Female doctors earn $2M less over their careers

Over the course of a career, the gender gap in earnings among doctors reaches seven figures, a new study has found.

Women doctors earn $2 million less than male physicians over a 40-year career, according to a study published Dec. 6 in Health Affairs.

Other studies have documented the disparity in earnings between men and women doctors. However, this new study is the first to capture the impact over the length of a career, said Christopher Whaley, a policy researcher at the RAND Corporation and lead author of the study.

He didn’t expect the career earnings gap to reach $2 million.

“That was a surprising number to see,” Whaley said in a phone interview. “That really is a stark difference in pay.”

Over the course of a simulated 40-year career, male physicians earned $8.31 million, while female doctors earned $6.26 million, the study found.

The disparities in compensation varied among different types of doctors.

The gender gap in earnings was largest among surgical specialists, with women typically earning $2.5 million less over their careers. Among non-surgical specialists, women earned $1.6 million less. Female primary care physicians earned about $900,000 less over their careers, the study found.

The study also examined the 10 most common specialties and found substantial pay disparities in each one. The smallest gap was seen in emergency medicine physicians, but the difference was still $621,952. The largest disparity among those 10 specialties was found in orthopedic surgery ($1,530,006).

It’s worth noting the study focused on full-time clinicians who typically aren’t in academic practice, Whaley said. The study may not fully capture the difficulties women have in choosing higher paying specialties.

“Our study probably understates the true differences in pay,” Whaley said.

The annual income differences appeared and accelerated at the beginning of physicians’ careers, the researchers found. He said it undercuts arguments that male doctors are earning more over time because they are treating more patients or securing more accomplishments.

“We found that those differences are apparent in year one,” Whaley said.

Even as women doctors gained more experience and were able to shed some nonclinical responsibilities, they didn’t close the pay gap.

“It’s not a story that male physicians are just more productive,” Whaley said.

The reasons for the pay disparities vary, the researchers found.

Gender bias and pay structures that put women at a disadvantage could be suppressing the pay for female doctors. It’s also possible that women physicians are less willing or able to change jobs and are less aggressive in negotiating compensation, the researchers said.

One study last year showed a possible explanation for the gap in earnings among women who are primary care physicians: they're spending more time with their patients.

A study published in the New England Journal of Medicine last year found women primary care physicians spend, on average, an additional 2.4 minutes with their patients. The study showed women generated 11% less in annual revenue because they were offering more direct patient care.

Women account for one-third of the physician workforce nationwide. About half of all medical school students are women, according to the Association of American Medical Colleges. Healthcare policy leaders have said it’s critical to get more women to pursue careers in medicine to address the physician shortage.

As more women become doctors, Whaley said it could help narrow the gender gap in compensation. The study found that pay disparities were particularly pronounced in practices heavily dominated by men. In practices where there were a fairly equal balance in the number of male and female physicians, the disparities didn’t tend to be as stark.

“If the practice is more gender diverse, we’re less likely to see these more egregious career outcomes,” Whaley said.

The study is garnering considerable media attention, including coverage in The New York Times. Whaley said there are reasons the study is resonating with people.

“What’s driving a lot of the attention is many women professionals know these factors exist,” Whaley said. “There isn’t good data to estimate the net impacts of these incremental disparities. Having these career numbers adds to the starkness of disparities in work-life balance and pay.”

Some are concerned women could be facing new career obstacles.

The COVID-19 pandemic appears to be having a disproportionate impact on the career of women physicians, according to a study published last month by Jama Network Open. That study found women physicians were more likely to reduce their hours, work from home or assume child care responsibilities. The disparities were even more pronounced among couples where both parents were full-time physicians.

Healthcare leaders are hearing more calls to support women physicians. The AAMC found 40% of women physicians shift to part-time hours or leave medicine within six years of finishing their residency.

Paid family leave policies and better child care coverage have been shown to reduce the gender gap in pay and other sectors and healthcare leaders should embrace those approaches, researchers said. Such policies could reduce pay differences earlier in the early years of practice, when women physicians are having children, and also could reduce disparities over careers. Those policies also could reduce burnout among women doctors.

In the New England Journal of Medicine study, the authors suggested another possible remedy is adjusting compensation models to reflect health outcomes and patient satisfaction.

Whaley endorsed those ideas and also suggested more transparency in pay could help close the pay disparity for women doctors.

“If women are providing better care and patients have better outcomes, it seems that’s something we should financially reward,” Whaley said.