Read on Twitter
The gender pay gap in medicine - a thread which I would like to dedicate to my colleagues who have been telling me for the last two decades that no such thing exists, this is the evidence. #womeninmedicine #ilooklikeasurgeon 
1/lots
1/lots
Firstly, a gender pay gap refers to a difference in money earned between the genders. It is an established measure of women’s position in the economy and is the result of social & economic factors that reduce women’s earning capacity @WGEAgency
One myth is that the fixing the gender pay gap is all about ensuring equal pay, such as through standardised pay grades. This oversimplifies the fact that the gap is from complex factors and requires cultural change to allow full participation of women in the workforce.
In Australia, the gender pay gap sits at 14% which equates to men earning $1812 per week and women $1558.40, if working full time. In medicine, the gender pay gap around the world sits at 20-29%, with gaps varying by specialties.
In surgery, a multitude of papers have investigated the gender pay gap and a large number of them are from the US where renumeration systems can be quite heterogenous. For example, female ENT surgeons earn 20% less, controlling for time spent at home https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/647661
COVID has exacerbated the gender pay gap in medicine, as reported in the UK - which is important since the UK uses a single payer (the NHS) meaning that there isn’t room for issues such as contract negotiation of private in the same way there is in the US. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32671-4/fulltext?rss=yes
Likewise, Canada has a fee for service model, similar to Australia, which demonstrated earnings 24% lower for female surgeons, with the biggest gap in cardiothoracic surgery. Quelle surprise. https://jamanetwork.com/journals/jamasurgery/fullarticle/2751882
Australia can deny this is an issue - we should get the same amount of money similar to Canada of the UK because of our health care structure. The gender pay gap can be as high as 64% here - male orthopaedic surgeons earn $439,629 pa, females $159,479 according to the ATO.
As we can see, a structured compensation plan does not fix this: https://journals.lww.com/annalsofsurgery/Abstract/2018/09000/A_Structured_Compensation_Plan_Improves_But_Does.6.aspx further hammering home that cultural change is important
It goes without saying (at least I hope it does), that in gender pay gap data, the intersection of gender and race exacerbates these findings. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336052/ - I can’t find Australian data on this
So what are the reasons?
- Compensation packages
- Female doctors do longer, less lucrative consults (e.g. mental health)
- Expectations around the fees women set
- Inequitable parental leave
- Women get more referrals for lower paid procedures
- Compensation packages
- Female doctors do longer, less lucrative consults (e.g. mental health)
- Expectations around the fees women set
- Inequitable parental leave
- Women get more referrals for lower paid procedures
Reasons (cont'd)
- Poor career progression/promotion
- More caring responsibilities
- Casual/locum contracts preclude maternity leave
https://www.amansw.com.au/are-we-there-yet/ https://www.cmaj.ca/content/192/1/E19.short
- Poor career progression/promotion
- More caring responsibilities
- Casual/locum contracts preclude maternity leave
https://www.amansw.com.au/are-we-there-yet/ https://www.cmaj.ca/content/192/1/E19.short
Childbearing and child rearing does affect pay but it is not the only reason - women without children still experience it. Men and institutions denying the existence of the pay gap is a huge problem - https://insightplus.mja.com.au/2013/34/gender-pay-gap-growing/
So how do we fix this? Some useful ideas from @HBR
- Enhance research and reporting into salaries and remuneration in medicine
- Pay transparency
- Sponsorship of women
- Equitable promotion
- General abolishment of gender bias in medicine https://hbr.org/2019/11/how-to-close-the-gender-pay-gap-in-u-s-medicine
- Enhance research and reporting into salaries and remuneration in medicine
- Pay transparency
- Sponsorship of women
- Equitable promotion
- General abolishment of gender bias in medicine https://hbr.org/2019/11/how-to-close-the-gender-pay-gap-in-u-s-medicine
Now importantly, what prompted this lengthy thread? I have had a few recent interactions with male colleagues who have tried to tell me that the gender pay gap isn’t real, especially in Australia, but any issues can be traced back to babies, which is intellectually lazy & wrong
Medicine is just so inherently sexist. Still. Have we made gains? Yes. But the stench still persists. And it’s becoming hard to challenge since we hide behind a never ending parade of courses and bias training that are supposed to fix the problem.
And yet, the data says otherwise. The experiences of women say otherwise. And the persistence of letting people into leadership positions when they deny the science, the data and the experience stops us changing it. Fin.
