The Gender Pay Gap in Medicine

The Gender Pay Gap in Medicine 2017-09-07T00:16:43+00:00

Grace Fitzgerald

There is a significant gap in the earnings of male and female doctors in Australia. 2016 figures demonstrate a 33.6% pay gap for full-time medical specialists, and a 24.7% pay gap among full-time general practitioners (10). When controlling for hours worked, the annual gross personal earnings for female specialists was on average 16.6% less than their male counterparts, and female GPs earned on average 25% less than male GPs (11). Some of this gap can be explained by the different career trajectories of male and female doctors – for instance the fact that male doctors are less likely to take time off work to raise children than their female counterparts. However, a large part of the pay gap is unexplained. At Level, we are working to understand the causes of pay inequity in medicine and to advocate for fairer workplaces.

Background

In 2015 females comprised 62.8% of graduates from Australian medical degrees. There was no observable difference between the starting salary in full-time employment between males and females (13). However, as female doctors progress in their careers they can expect to earn less.

Some explanations for the gender pay gap in medicine include:

  • That the relative recent entry of women into medical professions sees females concentrated in more junior positions and their underrepresented at more senior levels (7).
  • That female doctors tend to work in lower paid, less technically focused specialties (7).
  • That female doctors tend to undervalue their work and to be less successful in negotiating remuneration (8)
  • That females and males differ with regards hours worked and engagement in part-time employment (7)
  • That females and males are more likely to take time from work to support families or take other caring roles (9). As in many professions, female GPs with dependent children earn less than female GPs without dependent children, while male GPs with dependent children have higher earnings than male GPs who do not have dependent children (3, 9).

The pay gap exists within specialities and between them. Data from income reported to the Australian Taxation Office indicate that in some medical specialties such as orthopaedic surgery, ophthalmology radiation oncology and thoracic medicine, the pay gap percentage is at least 60% (12). While the ATO data does not control for hours worked, seniority of roles or access to discretionary pay, international analysis demonstrates that within-specialty discrimination exists even when controlled for other observable characteristics (8). Further research is required in Australia to understand what drives these disparities within and between specialties.

There’s more to the story

Importantly, the pay gap in medicine cannot simply be explained by differences in the way male and female doctors work: between a quarter and a half of the earnings gap between male and female GPs in Australia is not attributable to hours worked, career interruptions or employment type (9).

What can we do?

Leadership from professional medical organisations: At the time of writing, no major medical body or college has a formal policy position regarding pay equity practices. Many colleges state that pay equity is a matter of industrial relations. 2016 Workplace Gender Equity Agency Data indicates that only 9.1% of employers of specialist medical services have gender pay equity objectives included in their formal policy or strategy (10). No employers of GPs identified pay equity objectives in their formal policy or strategy (10). Formal commitments by employers can help to ensure equal remuneration for equal work (15).

Better data collection: A paucity of data pertaining to the breadth of factors that affect economic participation and remuneration limit our ability to ensure pay equity in medicine. Further research to identify any wage discrimination would inform practical responses to eliminate unjustifiable differences in pay received or similar work. Pay auditing or disclosure of salaries in organizations employing doctors would draw attention to pay gaps where they exist, and allow employees to challenge inequities in line with their legal entitlements (5).

Challenging systemic discrimination in specialty training: the underrepresentation of female doctors in highly paid specialties needs to be better understood in order to develop policy responses at the college and hospital level (6)

Female leadership: Increased representation of women on Boards and in leadership positions is associated with significant reductions in gender pay gaps (5). An imbalance of women in leadership positions in medicine might contribute to the persistence of conservative social norms and rigid career pathways, rendering it difficult for professionals to achieve balance between career, family and other caring roles (18).

Flexible training and working: support for flexible training and working options might minimize the obstacles to career progression faced by those doctors with family and domestic commitments outside of medicine (7, 18).

Future priorities for Level

  • Skills development in medical students and junior doctors to advocate for pay equity in their workplaces.
  • Supporting medical professionals to advocate for flexible working and learning arrangements.
  • Educate medical students and professionals about tackling unconscious gendered biases in the workplace.

 

References and further reading

  1. World Economic Forum. Global Gender Gap Report 2016. http://www3.weforum.org/docs/GGGR16/WEF_Global_Gender_Gap_Report_2016.pdf: World Economic Forum,, 2016.
  2. Agency WGE. Australia’s Gender Equality Scorecard. https://www.wgea.gov.au/sites/default/files/80653_2015-16-gender-equality-scorecard.pdf: Workplace Gender Equality Agency 2016.
  3. Cassells R, Vidyattama Y, Miranti R, McNamara J. The impact of a sustained gender wage gap on the Australian economy. National Centre for Social and Economic Modelling (NATSEM),, 2009.
  4. Sen G, Östlin P. Gender inequity in health: why it exists and how we can change it. Global Public Health. 2008;3(sup1):1-12.
  5. Bankwest Curtin Economics Centre and the Workplace Gender Equality Agency. Gender Equity Insights 2016: Inside Australia’s Gender Pay Gap. https://www.wgea.gov.au/sites/default/files/BCEC_WGEA_Gender_Pay_Equity_Insights_2016_Report.pdf: Bankwest Curtin Economics Centre and the Workplace Gender Equality Agency, 2016.
  6. KPMG. She’s Price(d)less: The economics of the gender pay gap. kpmg.com/au/paygap: 2016.
  7. Connolly S, Holdcroft A. The Pay Gap for Women in Medicine and Academic Medicine. British Medical Association,, 2009.
  8. Desai T, Ali S, Fang X, Thompson W, Jawa P, Vachharajani T. Equal work for unequal pay: the gender reimbursement gap for healthcare providers in the United States. Postgraduate Medical Journal. 2016;92(1092):571.
  9. Schurer S, Kuehnle D, Scott A, Cheng TC. One man’s blessing, another woman’s curse? Family factors and the gender-earnings gap of doctors. Bonn: Institute for the Study of Labor (IZA), 2012 Contract No.: IZA Discussion Paper No. 7017.
  10. Workplace Gender Equality Agency. WGEA Data Explorer http://data.wgea.gov.au [
  11. Cheng TC, Scott A, Jeon SH, Kalb G, Humphreys J, Joyce C. What factors influence the earnings of general practitioners and medical specialists? Evidence from the medicine in Australia: balancing employment and life survey. Health economics. 2012;21(11):1300-17.
  12. Taxation Statistics 2013-14. In: Australian Taxation Office, editor. http://data.gov.au/dataset/25e81c18-2083-4abe-81b6-0f530053c63f/resource/c506c052-be2f-4fba-8a65-90f9e60f7775/download/taxstats2014individual14occupationgendertaxableincome.xlsx.
  13. Graduate Careers Australia. Graduate Salaries 2015. http://www.graduatecareers.com.au/wp-content/uploads/2016/07/Graduate-Salaries-Report-2015-FINAL1.pdf: Graduate Careers Australia,, 2016.
  14. Wang C, Sweetman A. Gender, family status and physician labour supply. Social Science & Medicine. 2013;94:17-25.
  15. Peetz D. Regulation distance, labour segmentation and gender gaps. Cambridge Journal of Economics. 2014;39(2):345-62.
  16. Charlesworth S, Macdonald F. Australia’s gender pay equity legislation: how new, how different, what prospects? Cambridge Journal of Economics. 2014;39(2):421-40.
  17. Ombudsman FW. Gender pay quity. http://www.fairwork.gov.au: 2013.
  18. Bismark M, Morris J, Thomas L, Loh E, Phelps G, Dickinson H. Reasons and remedies for under-representation of women in medical leadership roles: a qualitative study from Australia. BMJ Open. 2015;5(11).