Like an illness without a cure, the question of why female physicians are paid less than their male colleagues remains unresolved.
A recent study of Medicare fee-for-service reimbursement found that after adjustment for frequently cited reasons for gender pay inequality, a statistically significant gender payment differential was still seen among physicians in 85 percent of 13 medical specialties evaluated.
The study, "Equal work for unequal pay: the gender reimbursement gap for healthcare providers in the United States,"(pmj.bmj.com) published online this month in the Postgraduate Medical Journal, analyzed more than 3 million Medicare Part B fee-for-service claims from 2012. This data set was selected to avoid bias stemming from self-reported income data.
The authors found the lowest unadjusted reimbursement gap was among family physicians, with a $15,000 difference between what male and female physicians were paid. The overall unadjusted differential for all specialties was $34,100.
To address often-cited reasons for gender pay inequity, however, the authors adjusted for work hours, productivity and years of experience using surrogate observations in the data set. Doing so put family medicine in the middle of the pack with a differential of $8,200. The overall adjusted differential for all specialties was $18,700.
The researchers acknowledged that even after the adjustments to account for the factors some point to as the cause of the pay gap between male and female physicians, they could not determine a real cause.
"Our findings suggest that the commonly held theories of why monetary disparities exist need to be revisited," said the authors,
"Most regrettably, we still do not have an answer as to why female providers are reimbursed less than their male counterparts," they concluded.
AAFP President Wanda Filer, M.D., M.B.A., of York, Pa., agreed that the numbers don't provide any clues about why the gender pay gap persists. And the problem exists in all types of practice arrangements.
"If you do same the work, you should get the same salary," she said of employed physicians. "Our goal should be that there is no gender gap."
In some fields, women earn less because of what researchers call the "inherent value" notion, whereby women set lower prices for their work. But this concept does not apply to fee-for-service medicine because Medicare and private insurers set standard prices for virtually all services that physicians perform. Filer said two reasons a pay gap persists in medicine may be because female physicians tend to spend more time with their patients and they "undercode" their services.
As for women entering into compensation negotiations with a prospective employer, "Some women are not comfortable negotiating for themselves," she said. "We are better advocates for others. We need to do a better job advocating for what we want."
Filer shares stories with female physicians about discrimination or large discrepancies in pay compared with men. She recalled one family medicine department chair in a major hospital system who received a substantial raise two years ago when hospital leaders realized she was vastly underpaid compared with her peers. Another physician was told by her superiors that she did not need to be paid more because her husband was already receiving a substantial salary.
"Sometimes employers say things to female physicians that they would never say to a male physician," Filer said.
When asked about the environment for female physicians today compared with when she completed her residency, Filer said the climate has improved, and blatant discrimination has decreased considerably. She recalled interviews early in her career when prospective employers would ask how many children she planned to have.
"They just figure you are going to disengage at some point," she said. "Clearly, I haven't.
"Given that 43 percent of our members are women, we need to make this right."
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