Many studies have suggested that female physicians earn less than their male peers. But a common critique of such studies includes the failure to account for the different choices that male and female doctors make in areas such as work hours and specialties. A new study, which parses those differences down by focusing on physician-researchers—a group that lead author Reshma Jagsi calls the "cream of the crop"—suggests that gender is very closely tied to salary.
"Disturbingly, even after we controlled for all of those other factors, we did find that male doctors were paid more than female doctors who were doing similar work, and the difference was $12,000 a year, or $350,000 over the course of the career," says Jagsi, an associate professor of radiation oncology and a researcher at the University of Michigan—Ann Arbor Medical School. "It's like saying all the male doctors will simply get a write-off of their entire med school debt and more."
Neither Jagsi nor her co-authors of the study, which appeared in the June 13 issue of the Journal of the American Medical Association, believe intentional discrimination is pervasive in academic medicine. But both men and women in medicine harbor an "unconscious bias" about gender and salaries, Jagsi says.
Since salary gaps plague even the "homogenous" group of "superstar" researchers, it's clear that the problem extends to the larger population of medical teachers and clinical care providers, Jagsi says. Although it can be difficult—or even impossible—to circumvent unconscious biases, Jagsi and other experts offer four tips for women seeking medical positions.
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1. Prioritize performance: The study demonstrates that a "good ol' boys club," with a firm hold on the purse strings, is "still alive and well in academic medicine," says Beverly Hills, Calif., psychiatrist Carole Lieberman. Had the researchers examined self esteem, Lieberman suspects they would have found that the women were wounded by "repeated struggles" to be properly valued by the men in power at their institutions.
But being more aggressive negotiators can be counterproductive and alienate women from medical recruiters, Lieberman warns. "Negotiate salary increases or perks based upon performance," she advises. "When [women] perform beyond what is expected, they will be in a better position to renegotiate for what they are truly worth."
2. Seek transparency: Although there's "almost a taboo" around discussing salaries in American culture, and many institutions have opaque salary practices, some have relatively open salary and promotion procedures, according to Jagsi. If women inquire about salary structure, and the department chairman says, "'Well, I just determine how good I think you are, and just trust me. I make sure [a promotion or raise] happens,' you might want to steer away," Jagsi says.
But just looking at publicly available data on a hospital's or medical school's website may be misleading. For example, on the website of the University of Michigan, Jagsi's employer, the salaries tend to cluster around a certain number, but that's because they don't include incentives, which can be "quite large," she says.
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3. Learn to negotiate: Many women, who mistakenly assume that sexism and gender differences don't exist, aren't even aware of the salary disparity, says Carolyn Payne, a second-year student at the University of Toledo's College of Medicine and the student representative to the American Medical Association's Women Physicians Congress. "It's not like we're talking to our peers, especially our male peers, [and] asking them what they are making," she says.
That's why it's so important for women—who naively think that simply doing a good job will earn notice and awards—to learn to negotiate, says cardiologist Sharonne Hayes, the director of diversity and inclusion at the Mayo Clinic in Rochester, Minn.
"Make sure when you have your periodic performance review that you are prepared to make the case for the value you bring to the work, can document what you have done since the last review, and to ask for what you are worth," she says.