Gender-based disparities in starting salaries common in academic medicine

A study using U.S. compensation data from 2019 to 2020 found that starting salaries were lower for women in 93% of subspecialties and that initial salary parity in these subspecialities could increase women's earning potential by a median of $250,075.

Male physicians in academic medicine have larger starting salaries than female physicians, leading to early-career disparities in earning potential, a recent study found.

Researchers used public data on mean debt and compensation for full-time academic physicians in the United States from 2019 to 2020 to estimate starting salary, salary in year 10 of employment, annual salary growth rate, and overall earning potential in the first 10 years of employment for each gender by subspecialty. They also modeled the estimated impacts of promotion timing and potential interventions, including equalizing starting salaries and annual salary growth rates. The results were published Feb. 18 by JAMA Network Open.

Compensation data from 24,593 female and 29,886 male academic physicians from 45 subspecialties (21 adult medical, 8 adult surgical, and 16 pediatric medical) were included in the study. Starting salaries were lower for women in 93% of subspecialties, salaries at year 10 were lower in 96%, mean annual salary growth rates were lower in 49%, and earning potential was lower in 96%. The 10-year net present value, which analyzes the value of different income streams over time, was a median of $214,440 (IQR, $130,423 to $384, 954) less for women than for men.

According to model estimates, delaying promotion from assistant to associate professor by one year reduced earning potential for women by a median of $26,042 (interquartile range [IQR], $19,672 to $35,671) and receiving no promotions reduced it by a median of $218,724 (IQR, $176,317 to $284,466). Equalizing starting salaries could increase women's earning potential by a median of $250,075 (IQR, $161,299 to $381,799) in the subspecialties where women's starting salaries were lower than men's, the model indicated. In addition, if annual salary growth rates were equalized, women's earning potential could increase by a median of $53,661 (IQR, $24,258 to $102,892) in the subspecialties where women's mean annual salary growth rates were lower, according to the model.

The study included data only from physicians working at academic medical centers, and the results rely on the model's assumptions, the authors noted. They concluded that starting salaries and early-career earning potential vary widely among men and women physicians in academic medicine and that most of the differences in earning potential are related to lower starting salaries for women. “Addressing these disparities is necessary to establish equity between health care practitioners,” the authors wrote. “An important next step involves addressing the gender-based disparities in compensation with ongoing measurement and programs that incentivize appropriate action and outcomes. This is vital to ensure equity for physicians and appropriate access to care for patients and their families.”

An accompanying invited commentary discussed the limitations involved in estimating long-term earning potential, including fluctuations in the assumed discount rate, and noted that the resource-based relative value scale should also be reviewed across specialties to examine gender equity. The commentary authors said that transparency about starting salaries and compensation benchmarks may be one way to decrease disparities and also recommended that academic medical centers periodically evaluate and adjust compensation. In addition, they said, women should be offered equitable opportunities, such as leadership positions, to increase their earning potential.