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Friday Sep 07, 2018

Why Does Equal Pay for Equal Work Still Elude Us?

As the previous century was nearing its end, the AAFP declared the 1990s a "Decade of Transition." As part of that movement, the National Conference of Women, Minority and New Physicians(3 page PDF) -- now expanded to include the international medical graduate and lesbian, gay, bisexual and transgender physician constituencies and renamed the National Conference of Constituency Leaders -- was first convened in August of 1990.

[male and female figures standing on stacks of coins]

One of the objectives of this event was -- and continues to be -- identifying issues of particular concern to these groups of family physicians and informing the AAFP Board of Directors and the Congress of Delegates.

During this Decade of Transition, the Academy also developed its physician payment policy.  Established in 1993 and still current policy, it states, in part, "There should be equal pay for equal work and no discrimination in physician payment in any form, including, but not limited to, that on the basis of actual or perceived race, color, religion, gender, sexual orientation, gender identity, ethnic affiliation, health, age, disability, economic status, body habitus or national origin of the physician."

A concern that was most vigorously voiced then, and one that still persists today, is equality of pay for female physicians. Currently, 44.2 percent of active AAFP members are women. However, the gender composition of the family medicine workforce is shifting, with women representing 53.7 percent of resident members and 51.6 percent of student members. The inequities that exist today will be amplified in the future if this problem isn't addressed.

Medscape's 2018 Physician Compensation Report(www.medscape.com) (and its derivative 2018 Female Physician Compensation Report(www.medscape.com)) recently illustrated that the problem isn't going away. In fact, it's getting worse. This self-reported survey revealed that male primary care physicians earn an average of $239,000 per year, or 18 percent more than their female counterparts, who earn an average of $203,000. However, this was not the most disturbing statistic. In Medscape's 2017 female physician survey,(www.medscape.com) the difference was 16 percent, so the pay gap is increasing.

This problem isn't isolated to primary care. Among subspecialists, the gap doubles to a 36 percent difference, with men averaging $358,000 compared with $263,000 for women.

This spring, the American College of Physicians published a position paper, titled "Achieving Gender Equity in Physician Compensation and Career Advancement,"(www.acponline.org) in the Annals of Internal Medicine that looked at faculty income for women and men. Following 24 medical schools longitudinally for 17 years, the authors found that women made 90 cents for every dollar earned by men. This resulted in women earning an average of $20,000 less than their male colleagues each year.

Many theories have been put forth regarding the causes of this inequity, such as female physicians working fewer hours than men, seeing fewer patients during the workday, spending more time with patients or having fewer years of experience. However, these explanations don't hold water.

In a 2016 study,(pmj.bmj.com) BMJ's Postgraduate Medical Journal looked at objective, nonself-reported data on this issue. In analyzing more than 3 million Medicare claims from 2012, the authors used National Provider Identifier numbers (NPIs) to identify the level of experience and gender of physicians in 13 specialties. Adjustments were made to account for the productivity of the physician, their level of experience and hours worked.

The results showed a negative differential in each of the 13 specialties reviewed, including statistically significant differences in 11 specialties. The overall average decrease in claims reimbursement for women across all specialties was $18,677.23. Of those 11 specialties, family medicine had the narrowest gap, but it was still significant at $15,029.77.

Much-needed attention is being drawn to this unacceptable discrimination. Earlier this year, the AMA House of Delegates, at which your AAFP has a seated delegation, adopted a new policy on pay inequities.(wire.ama-assn.org) The House called for the AMA to advocate that pay structures be based on objective, gender-neutral criteria, adopting a comprehensive gender equity measure(www.ama-assn.org) that encouraged "a specified approach, sufficient to identify gender disparity, to oversight of compensation models, metrics and actual total compensation for all employed physicians." Delegates also advocated training to identify and mitigate the implicit bias being used in compensation determination.

This is not just an issue for physicians. It is pervasive in our society. The nonprofit Institute for Women's Policy Research reported that in 2016, women were paid an average of 80.5 cents for every dollar earned by men.(iwpr.org)  

The persistence of this inequity is inexcusable, and we cannot tolerate it any longer. We must work within the House of Medicine to end this discriminatory practice and truly embrace the AAFP's long-held policy of equal pay for equal work.

Michael Munger, M.D., is president of the AAFP.

Posted at 10:42AM Sep 07, 2018 by Michael Munger, M.D.

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