Women in medicine earn about 20 percent less than men. That is a problem for multiple reasons. It is, of course, not fair to the women who go through the same training and have the same skills as their male counterparts. Worse still, if well-qualified women are discouraged from entering the profession because of this inequity, it is bad for patients.
The reasons for this pay disparity are complex. Because medicine is still largely a fee-for-service reimbursement system, the explanation cannot simply be that women with identical qualifications receive lower salaries for doing the same exact work as their male colleagues—although this does happen. A more complete explanation must take into account pay differences between specialties and differing reimbursement patterns within a specialty.
Specifically, there are three important drivers of this pay gap, all of which can and should be addressed: (1) The best-paid specialties are often unfriendly to women trainees; (2) The relative value unit (RVU) reimbursement system used in the United States favors specialties that attract more men; and (3) Men in procedural or surgical specialties receive more referrals for lucrative procedures than do women.
There are vast differences in payment between different specialties, and in most cases the top-paying specialties have historically been—and continue to be—dominated by men. Overall, while 65 percent of practicing doctors are men, according to the Association of American Medical Colleges, in the top 10 remunerated specialties, 80 percent are men. Aside from dermatology, which is composed of 49 percent women, the other top-paying specialties are heavily weighted to men, ranging from 74 percent for radiology to 95 percent for the top-paying profession, orthopedics. According to Medscape, the average US orthopedist gets paid $482,000 per year, while the average pediatrician, a specialty that is 62 percent women, makes $225,000—less than half as much.
A recent article in Stat News by Dr. Qaali Hussein illustrates one reason why this discrepancy exists. Many of the best-paid specialties are surgical or heavily procedural, which tend to be dominated by men. Dr Hussein describes a culture in her specialty, trauma surgery, vehemently resistant to motherhood. She quotes one of her senior residents saying, “anyone who chooses to get pregnant in a surgery residency is selfish.” Far from an isolated occurrence, this opposition to motherhood is prevalent in surgical specialties. Several of my friends in surgical specialties have faced similar reactions from their peers and supervisors.
If the medical profession is serious about promoting gender equality,