It is no secret that men and women are treated differently.  Throughout their entire lives, women have generally received treatment unalike, and unequal, to the treatment of men.  It is no secret that the inequality between men and women is an issue—and has been—an issue for years.   However, while the inequality between men and women is certain, the evidence between the discrimination is debatable.  One specific issue is the wage gap between males and females, and even more specifically, the wage gap between male and female physicians.  To understand the wage gap, it must be understood that it has been an ongoing battle, as “some of the earliest analyses of pay inequity were conducted in the 1970s” (Desai).  A study conducted by Dr. Anupam B. Jena in 2016, though, showed an unexplained pay gap of almost $20,000 between male and female physicians.  Despite arguments being made, there are multiple reasons why the wage gap exists, such as the perceptions and behaviors of women compared to men. Although there are arguments against it, the wage gap between male and female physicians does exist, with females earning less for the same amount of work, and there should be efforts taken to try to resolve it.

According to Christina H. Sommers, author and scholar of the American Enterprise Institute, explains the wage gap as the “difference between the average earnings of men and women working full-time” and it fails to account for the differences in positions, educations, job tenure, or hours worked per week.  In fact, a common response defending the wage gap is the phrase “equal pay for equal work” because many of the previous studies done regarding the wage gap focuses on individuals straight out of college post-graduate school along with individuals who have been in the workforce for years (Dubner).  So, it is no surprise that there is a gap.  In Dr. Jena’s study “Sex Differences in Physician Salary in US Public Medical Schools,” it showed that throughout the United States, female doctors were generally younger than men, had a greater percentage who specialized in internal medicine, obstetrics and gynecology, and pediatrics, completed residency more recently, were less likely to have received payments from Medicare, and had a salary distribution that was skewed left with a substantially higher proportion of women receiving lower salaries, among other things.  Compared to men, women earned a lower mean salary ($206,641 vs $257,957) due to the discrepancies of the age of the doctors, specialty, years since residency was completed, etc., which supports Sommers’s viewpoint that the gap does not always account for other factors besides wage.

However, Dr. Jena proves that the wage gap still exists when she made a multivariable analysis of the salaries of the physicians, adjusting for factors such as faculty rank, age, experience, years since residency, clinical trial participation, graduation from a highly-ranked medical school, and specialty. Her study showed that women still earned 8.0% ($19,879) less than men.  However, there is a positively correlated association between salary and years of experience, total publications, clinical trial participation, and Medicare payments.  Furthermore, there even existed discrepancy within medical specialty.  Jena observed that surgical subspecialties had the largest absolute adjusted differences in salary ($285,369 vs $329,097), and the subspecialties that contained the biggest differences are orthopedic surgery ($327,117 vs $368,070), hematology/oncology ($219,166 vs $256,959), obstetrics and gynecology ($253,387 vs $289,777), and cardiology ($229,940 vs $263,690).  Even with the adjustments of variables that may have accounted for the size of the wage gap, 38.7% of the unadjusted difference in mean salaries between men and women remain unexplained (Jena 1298, 1300-1301).

As seen in Jena’s study, it is obvious that doctors earn higher-than-average salaries, but it is a result of the strenuous amount of school and training prior to entering the occupation.  So, it is puzzling to see that although men and women are required to go through the same amount of school and training, the difference between the earning salaries male and female physicians is so wide.  It would make sense that male and female starting physicians would be on equal standing ground and be treated as such.  That is often not the case, though.  Even before entering the workforce, the “culmination of education, guidance by mentors, expectations of parents” throughout women’s lives aid in the discrimination that women feel, so the gap has already begun to form (Gould et al.).  When trying to decide whether they want to become a doctor, women form doubts because of the already preconceived expectations of the workforce.  Because of the perceived gender climate, such as sexual harassment, discrimination, and lack of mentoring, that poses as an obstacle to their career, women are more hesitant to enter the field of academic medicine.  As a result, compared to men, “women have slower career progress and are less likely to be promoted or tenured,” which would lead to women receiving a lower salary (McGuire 320).  So, even before really beginning to establish themselves as a physician, women already have obstacles that impede them from earning an equal salary as men.    

Once women are established physicians, the gap only grows.  There are multiple reasons as to why the gap exists, and part of the problem is that physicians themselves are not as aware as they could be.  Also, Anthony LoSasso et al. explore the reasons behind the gender wage gap among physicians and states that the “power of physicians’ observable characteristics (such as gender and specialty choices) to explain the difference in salaries diminished over time, which has created a widening unexplained starting salary gap between male and female physicians in recent years.”  There are a plethora of possibilities that can explain the inequity of physicians’ salaries, and it is difficult to pinpoint the exact ones.  A suggested explanation for the gap is the perception of women on their behavior and the presumptions of the work/family balance expected by their employers, co-workers, and the rest of society (Gould et al.).  Women tend to possess widely different associations that can factor in on why they are paid less than men.  Female doctors are often misconceived to be “shrill, emotional, precious, and soft,” therefore being construed as unable to perform as productively and paid accordingly (Srivastava).  The medical field is currently a testosterone-charged environment where a woman may be faulted for something that a man would otherwise be praised.  In an encounter in the hospital, oncologist and author Dr. Ranjana Srivastava recalled an instance where a male doctor was at risk of not meeting certain training requirements, and he was met with support and understanding.  On the other hand, a woman in the same conditions was seen unfit for the job.  As a result, male doctors are often requested over male doctors, which seriously depletes the number of patients that a female physician sees.  This is referred to as “on-the-job productivity” and is measured in terms of patients seen over a specified period of time.  Although it does not necessarily reflect the quality of care that a female physician gives, it is evidence of lower productivity (LoSasso et al.).

In addition, women are expected to be softer and more submissive than men, so when they attempt to negotiate for a higher salary, or look for jobs elsewhere, it is seen as out of character, and their attempts are often met with failure.   They are not as successful in negotiating salaries with their employer as men, who are known to be more aggressive concerning their salaries because of the “alpha male” persona that men tend to possess.  Since it is not socially acceptable for women to attempt to negotiate a higher salary, women will often just opt out because they do not want to pay the social cost, and employers will hire women who are likely to not even attempt at a negotiation (Arora 1305).  Since employers are generally used to paying women less than men, women are encouraged to accept the most beneficial job that they can.  Consequently, they are more willing to accept lower salaries in return for jobs that better reflect their broader employment preferences because they would rather have a lower salary than be without a job at all (LoSasso et al.).  

Perhaps the most prominent and obvious reason behind why women, and therefore female physicians, are paid less than men is because of the expectations the women has in terms of marital and family status.  Female doctors of all levels recounted less interest in the field because of a concern in balancing work life with family life (McGuire 320).  Many female physicians openly admit that being a dedicated doctor tests their marriage (Srivastava).  There is a stereotype that women are less productive during their child-bearing years, having to take time off from work to raise their children, which would explain why women get paid less initially.  In order to make sure they have time for their family, women often have to take the shifts that require less job responsibility, so they are able to leave at a moment’s notice in case of emergency.  Because of this, men are more likely to take upon those less desirable jobs that come with higher income (i.e. unfavorable call shifts or leadership roles), and they are able to have more time flexibility that would allow for more time in clinical trial participation, which, as seen in Dr. Jena’s study, is positively correlated to salary (Arora 1305). 

Once it is universally known that the wage gap between male and female physicians exists and why it exists, there needs to be methods taken to try to resolve it and make it smaller or, ideally, disappear altogether.  Yes, the wage gap has been a problem for years, which is proven by the multiple studies that have been conducted throughout the decade that all present similar results.  However, solutions cannot be made unless the motivation and willpower that is imperative to the movement is present.  It should not be the responsibility of the female physicians alone to close the gap; it must be a collective effort, and the findings from studies like Dr. Jena’s “provide clearer insight into this ongoing debate and reveal new considerations for medical institutions” (LoSasso et al.).  It is proven that female doctors are paid less than male doctors, and although the question of whether it rightfully exists is still debatable, the gap needs to be closed.  Suggestions of approaches to close the gap include employers implementing a pay transparency, hiring more female physicians, and requiring attendance to educational and empowerment interventions for all employees.  

Previous editor of Freakonomics, Bouree Lam describes pay transparency as the process of employers having to “report payroll data to the federal government, broken down by race, gender, and ethnicity.”  Pay transparency would ensure that employees would know exactly what they are earning, and it encourages employers to make sure they are treating their employees fairly.  This would help close the wage gap because the female physicians and others would know that they are being paid less than their colleagues and would act accordingly.  However, implementing pay transparency would not be enough.  Actions taken after the transparency is put in place are what would have the most impact.  If the pay transparency was there, and it showed that men were earning more for reasons unexplained, nothing was done about it, the purpose of the implementation would be moot.  An action that can be taken after pay transparency is executed is to institute a loyalty bonus.  Since female physicians are more likely to leave the job to accommodate their family life, a loyalty bonus would encourage those physicians with high performance to not leave their place of work (Arora 1305).

Although the wage gap is an old problem, there is evidence that the gap has narrowed over time because as participation of female physicians in the labor force increased, the wage has also increased (Gould et al.).  So, acquiring more women in the medical field would help close the wage gap because the increase in the demographics would “create a new set of provider preferences that includes more predictable schedules and less time pressures on other aspects of life,” so women can not only have the same salary as their male colleagues, but also the same opportunities and benefits (LoSasso et al.).  The first step to creating more female doctors is to encourage women to join the medical field.  Fewer women choose to major in STEM (science, technology, engineering, and mathematics) fields, and while it is not required for medical students to major in a science field, most medical students do come from a science major background (Gould et al.).  So, if more women are encouraged to major in a STEM field, the more likely they are to proceed to medical school and become a doctor.  Then, once they have become doctors, they can work their way into leadership roles to advocate for the elimination of the wage gap (Arora 1305).  Obtaining leadership roles is important because it will not only result in an increase in salary, but it will also provide female mentors as it is hard to find sustained mentors who can counsel other female physicians because so many of them have already left the field for a more fair and fitting work environment (Srivastava).  

Discrimination and gender bias against women is a substantial factor in the wage gap between male and female physicians, and a method diminish the prejudice against women that is already present in the work environment, education and empowerment interventions can be used. The John Hopkins University School of Medicine once held a study that suggested that “a multifaceted intervention can be successful by increasing promotions and salary equity…and decreasing gender bias” (McGuire 320).  As mentioned earlier, women are not as successful in negotiating their salaries, so providing programs that can work on building those necessary skills are a good way for female physicians to obtain those skills.  Alternatively, employers make the workshop a requirement before hiring the prospective employee to ensure that everyone is aware of the standards.  The interventions are proven to be effective because Stanford University implemented a required universal training program designed to reduce gender insensitivity and sexual harassment, and the study found that significant improvements in women’s faculty ratings and significant decreases in sexual harassment, gender discrimination, and gender insensitivity (McGuire 320).  It would be beneficial for female physicians to participate in these kinds of workshops because it would move them to an equal playing field, and it would be beneficial for male physicians to participate because it would ensure that they would be aware, and therefore not take part in any action, of gender discrimination or bias and sexual harassment.

Despite arguments saying otherwise, the wage gap between male and female physicians exists.  The almost $20,000 unexplained difference in salaries between men and women can be attributed to the constraints of gender roles and discrimination, unequal opportunities, and the absence of necessary skills that would ensure a well-deserved salary.  To begin to close the wage gap and keep it closed, several methods can be used, such as the enactment of pay transparency to ensure fair pay for all of an employer’s employees, an increase in the female physician labor force to provide preferences that would behoove all women in the medical field, and the requirement of interventions that would educate against gender discrimination to promote a fair and healthy work environment for women.  Female doctors have experienced the same amount of school and the same amount of training as male doctors, so they should receive the same salary.  Furthermore, beyond just female physicians, all women should be paid the same amount of money for the same amount of work.  
