Why do women in family medicine earn approximately 16% less than men, and what can be done to narrow the gap?
The wage gap between male and female physicians has persisted for decades, despite evidence that women provide care equal to or better than their male counterparts.1,2 In family medicine, women earn approximately 16% less than men after controlling for seniority and hours worked,3 resulting in a difference of $1.8 million over a 30-year career, according to one study.4 While estimates of the pay gap's magnitude vary, two aspects remain consistent throughout the literature: 1) the gap exists, and 2) much of it is beyond the control of individual physicians. Still, there are some steps individual physicians can take, and we should understand the reasons behind the gap so we can advocate for systemic change.
WHY THE GENDER WAGE GAP EXISTS
Research has identified several contributors to the gender wage gap. Women in family medicine are underrepresented in highly compensated practice settings, such as urgent care centers, and overrepresented in lower-paying settings, such as federally qualified health centers and academic institutions. Other contributors are related to practice patterns: Women often spend more time with each patient, which reduces the total number of patients they see per session.5 In a system where compensation is often tied to relative value units (RVUs) generated, this impacts salaries.
But even after controlling for these factors, the gender wage gap persists, indicating that it is not solely driven by practice patterns, practice type, or location.6
Gender-based social constructs also play a role in the wage gap. The societal expectation that women are more empathetic or better communicators may influence their tendency to spend more time with patients, serve as educators, and work in safety-net settings serving vulnerable populations.7 These same societal norms often place a disproportionate burden of household, child, and elder care on women, which can lead to reduced clinical hours or career interruptions and further impact earnings.
This begs the question: Should women adapt their practice styles to the current system, or should the system evolve? Given the evidence that women frequently deliver high-quality care and achieve higher patient satisfaction ratings, it is reasonable to argue that the system should adapt.
EFFORTS TO ADDRESS THE WAGE GAP
Moving away from the fee-for-service model that rewards volume and instead adopting payment structures that reward value would help narrow the gender wage gap. Other potential reforms include reimbursement parity between Medicaid and private insurers to support higher wages in safety-net clinics. While progress has been made in some of these areas, significant work remains.
Achieving gender wage equity in family medicine will also require efforts at the individual and organizational level, such as the following:
Tracking the evidence: Change starts with measurement. The AAFP's Robert Graham Center has a portfolio of work dedicated to the gender wage gap, with more than a dozen projects, publications, and presentations available on the center's website.8
Wage transparency: Salary data empowers physicians to negotiate effectively and make informed decisions about employment. While many health systems assert that salaries are non-negotiable and determined by factors such as specialty, revenue generation, and seniority, physicians still have choices about where they work. Moreover, some health systems offer additional compensation opportunities such as bonuses or salary supplements for leadership roles. It is especially crucial for women to understand these options as they negotiate and advocate for their total compensation. Although health systems typically publish salary ranges, they are often broad and provide limited practical guidance. Tools like the AAFP's Career Benchmark Dashboard allow family physicians to share and compare salary information, facilitating better career choices. More organizations could also be encouraged to provide financial incentives for nonclinical activities, such as volunteering to be on committees, which women disproportionately engage in.9
Salary history bans: Prospective employers often base salary offers on an applicant's past wages. Because female family physicians frequently start with lower salaries than their male counterparts for various reasons (including the differences in practice setting noted above), this can cause the pay gap to persist throughout their careers. Policies that prohibit health systems from considering salary history can mitigate these disparities and promote more equitable compensation.
Academic promotion practices: Many family physicians work in academic settings where faculty rank directly influences salary. However, extensive data shows that women tend to advance more slowly in rank than men.10 Academic medical centers can address this disparity by revising promotion criteria to value contributions beyond grant funding, a metric that often favors men.11 Additionally, they can ensure equitable representation of women on search committees and guarantee that leadership opportunities are widely advertised rather than privately offered to a select few.
Mentorship: Effective mentors can help women negotiate better salaries, identify career opportunities, and navigate systemic barriers. Physicians may find mentors within their institutions, but the AAFP also offers a directory of career coaches, many of whom are family physicians themselves.
Negotiation skills: Women may benefit from training in negotiation techniques to advocate for themselves in salary discussions, bonus allocations, and leadership opportunities. The AAFP has many resources to help physicians with negotiation skills, including a course specifically designed to address gender equity.12
MORE WORK TO DO
The gender wage gap in medicine is a multifaceted issue rooted in systemic and social factors. While individual efforts such as mentorship and negotiation skills can help narrow the gap one physician at a time, true equity will require systemic change in how physicians are paid. Transforming the health care reimbursement system to reward value over volume and to pay for nonclinical contributions such as teaching would not only narrow gender wage disparities but also improve the quality of care. Achieving gender wage equity is therefore not just a matter of fairness; it is an investment in the future of health care.
