With $300,000 in medical education debt and the intention of starting a family soon, third-year family medicine resident Meshia Waleh, M.D., of Durham, N.C., knows she'll need to negotiate when she applies for her first job, and she's boning up on how to do that effectively.
That, say various expert sources, is likely a smart move for a number of reasons -- not the least of which are the results of a study(content.healthaffairs.org) published in the February Health Affairs that show there's a significant and growing gender gap in the starting pay of new physicians, including family physicians.
According to the study, which was conducted in New York state, newly trained male physicians across all specialties earned, on average, more than $16,800 more in 2008 than did their female counterparts. In 1999, the pay gap was only about $3,600.
Among family physicians, the mean starting salary for men in 2008 was almost $147,900, whereas the mean for women was about $139,500. That's a difference of more than $8,000.
The study's authors said the widening gap cannot be explained by solely by specialty choice, practice setting, hours worked or other characteristics. Neither do they accept the theory that women have become worse negotiators. Instead, they suggest that women are paying attention to family considerations, as well as to salary and advancement potential, in their negotiations.
The AAFP has a number of resources to help members seeking a new position:
- AAFP CareerLink(www.aafpcareerlink.org) allows job seekers to create an online resume, view positions offered and create customized job alerts.
- The AFP/FPM Career Center(www.afpcareercenter.com) is an extension of the recruitment ads found in the pages of American Family Physician and Family Practice Management. Job seekers can search and apply for jobs, upload their resumes in document and video format, save their job searches and receive personalized job alerts.
- Income data for FPs by location, type of practice and other variables is available online. In addition, the "2009 Review of Physician and CRNA Recruiting Incentives"(www.merritthawkins.com) published by Merritt Hawkins & Associates offers insight on what other specialties are earning.
- Information and tips on contract negotiations and physician work-life balance also can be found online.
"It is possible that … physician practices may now be offering greater flexibility and family-friendly attributes that are more appealing to female practitioners but that come at the price of commensurately lower pay," said the authors.
"Thus, instead of being penalized because of their gender, female physicians may be seeking out employment arrangements that compensate them in other -- nonfinancial -- ways, and more employers may be beginning to offer such arrangements."
Perry Pugno, M.D., M.P.H, director of the AAFP Division of Medical Education, told AAFP News Now that he has noticed female family physicians tend to do more part-time and outpatient-focused work, which pays less than, for example, a rural full-scope practice.
"The reality is that if you want flexibility, you will get a lower income," said Pugno. "More inpatient care, obstetrics and night call do limit your flexibility, but they also pay better."
According to Viviana Martinez-Bianchi, M.D., associate director of the Duke Family Medicine Residency Program in Durham, N.C., and chair of the AAFP Commission on Membership and Member Services, both male and female residents in her program seem to be seeking more flexibility and family time. However, she added that she has noticed gender differences in approaches to compensation, depending on a new physician's personal financial circumstances and his or her experience in business.
Jack Valancy, M.B.A., a health care consultant, clinical assistant professor in the department of family medicine at Case Western Reserve University in Cleveland and contributor to Family Practice Management, says men and women physicians display a broad range of negotiating skills and approaches -- from passive to assertive to aggressive. No one style is exclusive to either gender.
"One of the most passive negotiators I advised was a male physician, and one of the most aggressive was a female," he told AAFP News Now.
According to Valancy, both genders increasingly are concerned about lifestyle issues. He said he recommends that both men and women identify their top career issues, including what they prefer as well as what they want to avoid.
Other tips Valancy offered FPs:
- assess how well each potential job satisfies your key career issues,
- don't be shy about asking for what you want,
- shop around and
- walk away from a bad deal.
Don't forget, Valancy said, "Family physicians have more leverage in markets with high demand and low supply of physicians; less leverage in markets that are saturated with physicians."
For example, Martinez-Bianchi said, a married woman physician with a high-earning husband may be less likely to haggle over a salary offer. Women also may be less sure about how to negotiate.
"My own residents tell me that women are less likely to fight for a salary, that (women) will tend to take what is offered -- unless they have been trained in business before," she told AAFP News Now.
Waleh said that when it comes to finding the right job fit, money is important because of her high medical school debt, but so is flexibility. When she completes her training in June, she and her husband, who is an information technology specialist, plan to do mission work in Honduras. When they return, the couple wants to start a family.
Waleh said her first choice in the job search will be a family medicine clinic, but she also wants to work in health policy. She's aware that as part of some compensation packages, companies will pay thousands of dollars a year toward a physician's medical school debt, but the salary may be lower.
Established physicians have told Waleh that she has to know what she's worth and she has to be both assertive and knowledgeable in her negotiations. They also have told her about ways to increase her earnings, such as through supervising midlevel providers or offering special services in the community.
Still, Waleh said she believes there are basic differences in the way men and women approach their first jobs. "If a woman has children and wants to go to soccer games, she might negotiate for that afternoon off, even if it requires a pay cut," she said. It's all about priorities, and they are often different for the two genders, she added.
"Men want to work and provide for their families," Waleh said. "Women want to be with their families and will make changes to accommodate that."