Sept. 7, 2018 (ACP) – When Dr. Ana María López, president of the American College of Physicians, was first starting out, she didn't consider negotiating her starting pay. “I met my division chief, he said ‘Welcome, this is your salary,” and I said ‘‘Thank you’ and we shook hands.”
It wasn't until years later, when attending an early career women faculty development session, that López learned that salary, along with other benefits, can be negotiated, and that male physicians earn more than their female counterparts.
Today, though, salary inequity is still the case for many female physicians, according to a new ACP survey published in Annals of Internal Medicine. Female doctors – regardless of specialty, number of hours worked, practice characteristics and region – make about $50,000 less than male physicians. Put another way: Female doctors earn 80 cents for every dollar earned by men. The precise differences do vary by specialty, from a difference of $29,000 for internal medicine specialists to $45,000 for subspecialists, the survey found.
“This is not surprising, but it is still dismaying,” López said. ACP's new report “really adds to the body of literature on differences in compensation for men and women in medicine.”
Some of this disparity may be due to female doctors' failure to speak up and negotiate from the get-go, she said. “Because women don't negotiate, we start at a lower salary and the gap widens over time as people progress in their careers.”
To close the gap and achieve gender equity in physician compensation and career advancement, ACP is calling for:
- Adoption of equitable compensation policies in all organizations that employ physicians
- Investment in leadership development, negotiation and career development programs
- Parental and family leave policies that provide at least six weeks of leave for physicians, residents and medical students, regardless of gender
- Implementation of regular implicit bias training by all health care organizations
This multi-pronged plan is outlined in an ACP position paper published this spring in Annals of Internal Medicine.
To help remedy the situation, there's a lot that individuals can do, too, López said.
“The very first step is awareness,” she said. “Everybody needs to gather information about starting salaries.” In academic medicine, the Dean of Faculty typically holds that information, and in private practice it's usually held by human resources.
People should ask themselves, “Are you in the range or not?” she said “And if you are not, you must find out why.”
López noted that there may be reasons that have nothing to do with gender that may explain some salary inequities. “You need to understand what currency will get you from A to B in your community and practice structure,” she said. For example, it may be that joining committees or applying for grants can get you a higher salary.
There's also more to equity than just a higher salary, López said. “You may want a higher salary, but may not need as many benefits,” she said. “There is always room to compromise and negotiate. Practice asking in a straightforward way and know what your bottom line is.”
When Dr. López started as a research associate professor, she said, she and another female were given cubicles. “When I looked around, I saw that the male physicians had an office with a door that shut,” she recalled. “I asked for an office and I got one.”
The full results from ACP's survey, “Compensation Disparities by Gender in Internal Medicine,” are available on the Annals of Internal Medicine website. ACP's position paper on gender equity is also on the journal website.