A review of 1120 senior theses submitted to fulfill the requirements for graduation from the Yale School of Medicine documented disparity in the rates at which women received a coveted designation of “highest honors.” Women authored 51% of submitted theses, but earned only 31% of highest honors awards (odds ratio [OR], 0.41, 95% CI, 0.23-0.74). Men were more likely to work with a mentor with a history of multiple thesis honorees, take an additional year of study, secure competitive research funding, undertake a Master’s degree, and conduct laboratory research. Yet even after adjustment for these factors, women were still less likely to receive highest honors.6
Salary discrepancies are documented even within seemingly homogenous groups of physicians. In a survey of recent recipients of NIH mentored career development (ie, K08 or K23) awards, the mean salary was $141,325 for women and $172,164 for men. Male gender remained an independent, significant predictor of salary (+ $10,921, P < .001) even after adjusting for specialty, academic rank, work hours, research time, and other factors. Ten to 17% of the gender disparity was unexplained by of the variables the investigators examined.7
Unconscious or implicit bias continues to drive decisions made about hiring, compensation, promotion, access to internal resources, and the climate in which women physicians work.
In a famous demonstration that scientists are susceptible to subtle gender bias, Moss-Racusin and colleagues designed faux applications for a laboratory manager position.8 These were identical with the exception of the names of the application, some of which were male and some of which were female. When these were submitted to 127 male and female professors, male candidates were rated significantly better and were offered higher salaries than female applicants.
Successful strategies to increase fairness and diversity in hiring in medicine include more metric-based, conscious decision-making rather than following a “gut feeling” about a candidate. Establishing a job description and list of qualifications prior to launching a search, allowing time for review of CVs and publications, and use of structured questions can all allow fuller evaluation of women or candidates from underrepresented groups.
The #MeToo movement has inspired many women to relate stories of harassment, and again medicine is no exception. The power differentials in hospitals, the scale of the investment of money and effort required of students to get into medical school or a competitive training program, and even the geography of the hospital and the call room may render women in medicine particularly vulnerable to harassment and particularly unwilling to complain when harassed. Harassment intimidates and marginalizes women, and can lead women to drop out of a program or leave a good position. The ways in which these effects contribute to unhappiness and burnout, and interfere with success, strong negotiating, and competitiveness for leadership positions are just starting to be explored.
A large body of evidence now exists to demonstrate that the gender pay gap is pervasive in medicine, that it cannot be fully explained by the personal choices of individual women who are not fairly paid, and that a lower valuation continues to be placed on work when it comes from a woman. This is the case despite the fact that women now represent over half of new medical school enrollees, provide medical care that leads to superior outcomes, and that these attainments come in spite of a climate that is consistently less supportive to women than to men.
Yet each of our trainees, each young doctor who brings the gifts and the years of study and service that are the price of entering our field, deserves an equal chance to succeed and an equal chance to be valued for that success. It is past time for some models to narrow these pay gaps, rather than a further series of papers demonstrating that they exist.
- Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Intern Med. 2017;177(2):206-13. doi: 10.1001/jamainternmed.2016.7875
- Jena AB, Khullar D, Ho O, Olenski AR, Blumenthal DM. Sex differences in academic rank in US medical schools in 2014. JAMA. 2015;314(11):1149-58. doi: 10.1001/jama.2015.10680
- Jagsi R1, Biga C2, Poppas A, et al. Work activities and compensation of male and female cardiologists. J Am Coll Cardiol. 2016;67(5):529-41. doi: 10.1016/j.jacc.2015.10.038
- Guarino CM, Borden VM. Faculty service loads and gender: are women taking care of the academic family? Res High Educ. 2017;58(6):672-94. doi: 10.1007/s11162-017-9454-2
- Patton EW, Griffith KA, Jones RD, Stewart A, Ubel PA, Jagsi R. Differences in mentor-mentee sponsorship in male vs female recipients of National Institutes of health grants. JAMA Intern Med. 2017;177(4):580-2. doi: 10.1001/jamainternmed.2016.9391
- King JT Jr, Angoff NR, Forrest JN Jr, Justice AC. Gender disparities in medical student research awards: a thirteen-year study from the Yale School of Medicine. Acad Med. 2017 Nov 14. doi: 10.1097/ACM.0000000000002052 [Epub ahead of print]
- Jagsi R, Griffith KA, Stewart A, Sambuco D, DeCastro R, Ubel PA. Gender differences in salary in a recent cohort of early-career physician-researchers. Acad Med. 2013;88(11):1689-99. doi: 10.1097/ACM.0b013e3182a71519
- Moss-Racusin CA, Dovidio JF, Brescoll VL, Graham MJ, Handelsman J. Science faculty’s subtle gender biases favor male students. Proc Natl Acad Sci U S A. 2012;109(41):16474-9. doi: 10.1073/pnas.1211286109
This article originally appeared on Cancer Therapy Advisor