Gender Wage Gap Remains for PAs

In my last blog, I discussed wage disparities between male and female Physician Assistants (PAs), as reported in a research article published recently in Women's Health issues. In this blog, I wanted to talk about some of the policy recommendations made by the authors, as I believe they have some bearing on the future direction for gender wage disparity in the PA profession.

This wage disparity also has implications for physicians, even though there is not yet the female dominance that is a major characteristic of the PA profession.

The first observation and recommendation relates to the employees themselves. Who would have thought it? Men and women are different when it comes to negotiating salaries and benefits. The authors looked at a number of other studies that documented that men persist with negotiation even when there is nothing to indicate that there is room for negotiation. Men and women are the same when it is clear that there is room for negotiation. The message here from the authors? Everything is negotiable and should be treated as such.

Second, we need to do a better job in preparing young PAs for all aspects of working life in the health care system. We have done a good job of training PAs in the nuts and bolts of caring for patients, but we have not done a good job of preparing new PAs for negotiating salary and benefits.

Honestly, after 37 years of practice and a number of different jobs and settings, I have learned everything that I know about salary and benefit negotiation through making mistakes and talking with my peers. Now, I make myself available to young PAs with questions about salary and benefits negotiation to help them ask the right questions and understand their economic power.

The third observation and recommendation relates to the employer. This is complicated by the fact that the environment for PA employment has drastically changed over the decades that I have been a PA, much as it has for physicians. Fewer PAs are working for solo physician practices and more PAs are working for institutions and large groups. There are people making the hiring and compensation decisions, who may not understand PAs, or use hiring and compensation decisions that are not a good fit for hiring PAs.

For example, because female PAs make less than men, compensation decisions that take into account past salaries, handicaps women. I never divulge to a potential employer past salary for this very reason, and, frankly, it is irrelevant to the negotiating process.

Employers should be more transparent about salary, but I have never seen an organization, large or small, that wants employees or the public to know what they pay individuals. Why? Because they know that this information will be bad for morale, and contributes to dissatisfaction and possible public criticism regarding implied or perceived bias. I think that I am worth more than the average PA because of my experience, and the diversity of my skill set. You can't just put all PAs in the same bucket and come up with homogenous compensation. I want to be rewarded for exceptional performance with exceptional pay.

What we need to work on is a world and health care system where a given female and male PA, with the same skills and experience, are compensated the same. We obviously have a long way to go, and this is a very complicated problem with a lot of moving parts. The first step before prescribing a treatment, is to understand the underlying problem.

The authors concluded that professional associations play an important role in both advocacy and education. The America Academy of PAs (AAPA) policy on this states: "AAPA believes in gender-based equity in income for PAs having comparable responsibilities within the same specialty. AAPA encourages research on gender-based disparities in income."

Beyond that, organizations serve a role in gathering and keeping current data on gender compensation inequality, educating their members and PA employers on inequalities, and providing their members with the tools and training needed to successfully negotiate their compensation packages. The more we understand about gender-based compensation inequalities, the more likely it is that we can adopt solutions the close the wage gap.