Significant differences in starting salaries for male and female physicians persist since 1999

Lower salaries for women were due partly to specialty but could not be explained by the greater importance they placed on schedules that allow work-life balance, the study found.

The earnings gap between male and female physicians has persisted for nearly twice as long as has been previously researched, a study found.

Researchers analyzed how the gap between the sexes in total starting physician pay evolved and the extent to which preferences in work-life balance factors are responsible by examining differences in starting salaries for a period of nearly two decades from 1999 through 2017, more than twice the length of time examined in prior research. Results were published Jan. 22 by Health Affairs.

The analysis focused on graduating residents and fellows who reported that their primary activity would be patient care/clinical practice in a nontraining position. Overall, 9,042 men and 7,005 women who started a job between 1999 and 2017 were included. In the 2014-2017 surveys, new questions were added about work-life balance and previously unmeasured family and relationship variables for 1,802 men and 1,684 women. Respondents were asked how important it was to have control over the start and end of the work day, the length of each work day, the frequency of overnight call, and the frequency of weekend duty. Preferences for each were rated on a four-point scale: “not important at all,” “of little importance,” “important,” and “very important.”

Women were consistently more likely to rate control over each measure of work-life balance preference as “very important” in comparison to men, with the difference ranging from 9 percentage points to 12 percentage points. In this subsample, women were more likely to work in primary care and less likely to report spending more than 50 hours per week in patient care versus men. Base salary and “anticipated additional incentive pay” (bonuses) were added to calculate total salary. Salary was adjusted for inflation using the Consumer Price Index and was reported in real 2017 dollars. Mean annual starting compensation averaged $235,044 for men and $198,426 for women over the entire period, a difference of $36,618 in real 2017 dollars.

Men and women were similar in sociodemographic and practice characteristics, but women chose primary care fields more often and surgical specialties less often. Specialty consistently explained 40% to 55% of the total starting pay differences, with a mean share over the entire period of 46%. Men reported having had six or more job offers more often than women, and differences in the number of job offers explained 2% to 9% of the differences in starting salary, with a mean share over the entire period of 5%. Hours of time spent in patient care explained 7% of the starting salary difference. No other factor explained more than 1% of the difference. On average, 39% of the total salary difference was unexplained.

Work-life balance, including the importance of predictable hours, length of the work day, frequency of overnight call, and frequency of weekend duty, had virtually no effect on the starting salary differential between men and women, nor did relationship and family status measures, the authors noted. “Taken together, our findings—or lack thereof—leave unanswered the question of what unmeasured factors can account for the unexplained gender gap in starting physician salaries,” they wrote.

The authors called for greater transparency in determining salaries, as well as for residency programs to set expectations for graduating residents and disseminate information to aid and educate them about salary negotiations. “If pay differences are the result of conscious choices, let them at least be well-informed choices,” they concluded.