By Marilynn Larkin
NEW YORK (Reuters Health) - Physician salaries are up, and so is the gender pay gap, according to the Medscape 2019 Annual Physician Compensation report.
Male physicians now earn 25% more than their female counterparts, up from 18% in 2018 and 16% in 2017. While the difference between men and women specialists dipped somewhat, the gap is still substantial: men now earn 33% more than women specialists; in 2018, they earned 36% more.
With the exception of ob/gyn, women often practice in one of the lower-paying specialties. For example, women make up less than 20% each of the highest-paid specialties - orthopedists, plastic surgeons, urologists and cardiologists.
Yet, the preponderance of women in lower-paying specialties doesn't explain the pay disparity within each specialty, according to the report, released April 10.
The reason for the gap is multifactorial, "starting back in the 'old days' and lingering to this day,' says the report's author, Leslie Kane, who is Senior Director, Medscape Business of Medicine.
"For decades, the attitude was that women's work, no matter what it was, was the 'second salary,' and didn't need to be as much as a man earned, because his was the salary that was supporting the family," she told Reuters Health. "That attitude has persisted and is particularly an anachronism today, when so many women are single/divorced and are the breadwinners for their family. This attitude needs to change."
"Some experts...have said that women are traditionally less aggressive when it comes to negotiating salary and benefits and have been more accepting of whatever salary/pay is offered," she said by email. "This could possibly be another contributing factor to the pay disparity."
Overall, on average, physicians are earning $313,000 in 2019. This includes an average $232,000 for primary care physicians and $341,000 for specialists, representing increases of 21.5% and 20%, respectively, from four years ago.
Two physicians - one male, one female - from the David Geffen School of Medicine at the University of California, Los Angles, were not surprised by the findings.
Dr. Isaac Yang, an associate professor of neurosurgery, told Reuters Health by email, "As a male surgeon in a male-dominated field, (the report) is consistent with what I have personally seen and experienced in the past 15 years."
However, his colleagues in law, journalism, education and business "also recognize the gender pay gap," he noted. "As we create a more diverse and balanced physician and specialist profession, this gender gap is likely to change, but this change is too slow. I am the proud father of three young girls, so this issue is important to me, as it should be to everyone."
Like Kane, Dr. Nina Shapiro, a professor of head and neck surgery, told Reuters Health, "Sadly, women are notoriously poor negotiators, often feeling that they are not worthy of the high numbers that male counterparts earn. They are more willing to accept less, not only when it comes to finances, but also when it comes to other job benefits."
"Women in solo practice tend to be better about finances, but those in group settings continue to be lower earners and poor negotiators," she said by email.
The survey revealed another gender gap: In primary care, men spent 9% more time with patients than women did, amounting to an additional four hours per week. But, Kane notes, "that doesn't mean that either women or men are spending more time with each INDIVIDUAL patient. It's possible that men and women are spending the same amount of time with each patient; but that men are spending more time seeing patients, overall."
"One possible contributing factor is that many more men are self-employed - partners or practice owners - than are women," she said. "When a physician is self-employed, spending more hours seeing patients indeed adds to revenue. In fact, once overhead has been met, four hours additional per week seeing patients could potentially be pure profit."
The percentage of self-employed physicians is somewhere around 35% to 40%, she noted.
Another possible factor is that more women physicians say quality of life and flexibility in their schedule are most important to them, whereas men more often say income and control over certain aspects of their practice are important. "This difference in values might affect hours worked and/or productivity goals in a job," Kane said.
The report is based on responses of close to 20,000 physicians in more than 30 specialties.