Work-life preferences not enough to account for physician gender pay gap, study says

Unadjusted differences between male and female physicians in mean starting salaries, by selected characteristics 1999-2017; Click to View

The gender pay gap between male and female physicians is often attributed to the emphasis each individual places on his or her “work-life balance preferences”; however, the results of a study conducted by the Center of Health Workforce Studies of the University at Albany, State University of New York suggest that these work-life balance preferences are not enough to explain the gap in pay. 

Anthony T. Lo Sasso, PhD, professor and Driehaus Fellow at DePaul University; David Armstrong, project director and Gaetano Forte, assistant director of the Center for Health Workforce Studies; and Susan Gerber, MD, associate professor of obstetrics and gynecology at Northwestern University authored a recently published paper on their analysis of physician income. 

The authors analyzed data from the New York, New York Survey of Residents Completing Training, conducted by the Center for Health Workforce Studies of the University at Albany, State University of New York, for graduating residents and fellows between the years 1999 and 2017. 

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According to the article, this particular data was chosen because New York reportedly trains more resident physicians than any other U.S. state. Furthermore, the authors say that the value in this particular data set lies in the unobserved differences in productivity and work experience in physicians accepting their first non-training position as opposed to a wider range of physician seniority. 

The authors found that the mean starting compensation for recently graduated physicians was about $235,044 for men and $198,426 for women-a difference of $36,618 in 2017. 

Sociodemographic and practice characteristics were the same among members of this group. 

Some key findings of the analyzed group include:  

• Women chose primary care fields more often, and surgical specialties less often, than men

• Women did not commonly report spending high amounts of time (i.e. 50+ hours per week) in direct patient care, relative to men

• Men reported having six or more job offers, relative to women

• Men had slightly higher rates of partnered status and having dependent children than women

• Women were consistently more likely to rate control over each measure of work-life balance preference as “very important’ compared with men (a difference of 9-12 percentage points). 

The author’s subsample retained all of these characteristics, as well as an additional likelihood of women surveyed to work in primary care and less likely to report working over 50 hours per week in patient care. 

A covariate-adjusted regression model was conducted, which the authors say allowed them to estimate the extent to which gender differences in salary were attributable to the stated difference in preferences about work-life balance factors, with other covariates controlled for. 

Salary was measured as the sum of starting salary plus any anticipated bonuses. 

• In 1999, this unadjusted difference in mean starting salary between genders was $24,000; in 2017, it rose to $48,000. Both differences were deemed quite high by the authors. 

• With other factors controlled, the unadjusted difference in mean starting salary between the genders in 1999 was $7,700 and rose to $20,200 in 2017. 

The authors say that the inclusion of variables regarding work-life preferences and relationship or familial factors resulted in negligible changes (i.e. less than $1,000). A restricted analysis of physicians in primary care fields where both men and women were “reasonably represented” (i.e. internal medicine, family medicine, and pediatrics) as a sensitivity check and found that the results were qualitatively similar and retains the significance of their earlier findings.

As an additional sensitivity analysis, the authors estimated models with only starting base salary measures the outcome variable to determine whether bonuses (or expectations thereof) would skew findings. The results returned no qualitative changes, according to the authors.

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“Our analysis showed that physician-stated preferences for controlling work-life balance, including having predictable hours, the length of the workday, the frequency of being on call overnight, and the frequency of weekend duty had virtually no effect on the starting salary differential between men and women,” the authors write. 

Physician specialty was found to be the greatest contributor to pay differences regardless of gender, consistently explaining 40-55 percent of the total starting salary differences. Over the entire period between 1999-2017, specialty accounted for 46 percent of the mean share. 

The authors say that differences in job offers reflect either the search efforts made by new physicians or the demand for their particular specialty, and accounted for 2 to 9 percent of the differences in starting salaries.   

Hours reportedly spent in patient care contributed to pay differences as well, accounting for nearly seven percent over the entire period analyzed. 

Despite these factors, the authors emphasize that there are still 39 percent of unaccounted factors that may be contributing to the differences in starting pay gap between men and women physicians. 

“The implication for the medical profession is that there is a need for continued vigilance in ensuring pay equity,” the authors write. “There may nevertheless exist workplace biases, whether intentional or unintentional, that differentially affect women irrespective of their individual stated preferences for work-life balance."

References:

Lo Sasso, Anthony; Armstrong, David; Forte, Gaetano; Gerber, Susan E. Differences in Starting Pay for Male and Female Physicians Persist; Explanations for the Gender Gap Remain Elusive. Health Affairs. 2020.