A paper published in this month’s issue of Academic Medicine is getting a lot of attention. Well, a lot for a paper published in a journal which rarely gets a glance from anyone not immersed in the minutia of medical education. Appearing under the section Gender Studies, Activities, Productivity, and Compensation of Men and Women in the Life Sciences examines  the pay of men and women who are faculty (PhD’s and MD’s) in medical schools; it also discusses other issues that I will not comment on here. The mere fact of its publication tells you its conclusion: “A substantial salary gap still exists between men and women that cannot be explained by productivity or other professional factors.” The word “sexist” which had been avoided throughout the paper finally sneaks into its last paragraph.

The study deserves scrutiny before accepting its conclusion. To begin with it’s a mail survey which of course is a big limitation. The response rate to this mailing was quite high – 74%. “In 2007, the authors conducted a mailed survey of 3,080 life sciences faculty at the 50 universities whose medical schools received the greatest amount of National Institutes of Health funding in 2004.” [Quotation from the paper’s abstract] The details of how the participants were selected as well as the other methods used in analyzing the data are described in the paper linked above which is available to anyone interested.

But let’s ignore the limitations of this kind of survey and see if the data it presents are adequate to justify the conclusion quoted above. To start with the study didn’t have that many women in it. Of the 2168 respondents only 593 were women. This disparity is by itself enough to cast some doubt on its finding. Furthermore, in order to preserve anonymity the survey did not ask information about department or specialty. This is a big problem because different specialties in medicine command very different incomes.

An interesting finding of the study was that young male medical faculty (assistant professors) worked longer hours than their female contemporaries. They also spent more time on research. Success in academic medicine is largely the result of success in research. If you’re spending more time on research as a young faculty member you’re more likely to be successful later on. The authors try to account for all the disparate variables and make this statement: “After control for all independent variables, female faculty members reported salaries that were, on average, $13,228 lower than those of comparable males (P< .001).” I don’t know how they were able to make all these adjustments because it’s astonishingly difficult to do. But even if they were able to accomplish this feat the study is most notable for what’s not in it.

There is no mention of marital status or of children in this study. It’s been known for about a century that single white women earn about the same as men. I’ve posted below Highlights of Women’s Earnings in 2008 compiled by the Department of Labor. The data in this report show that never married women have an income 94% of that of men. If you were to look at white never married women there would be no disparity at all. What I’m trying to get at is the effect of gender on income independent of anything else that might be responsible for a difference.

What appears to be in force here is biology – not a biological difference between the sexes in capacity but a difference that both biology and habit impose on family life which in turn affects a wife’s income. It’s no surprise that the burden of family life falls disproportionally on women. Pregnancy, the care of young children, the care of a husband, the raising of children all negatively affect a woman’s income. This is not to say that women take a financial hit when they marry – family income may be much greater than if the woman had remained single, but the income she earns under her own name is typically less than had she remained single.

As I mentioned above there is no information about the marital status and family structure of the women faculty members who responded to this survey. If these factors had been considered it is possible, perhaps likely, that no disparity in income would have been found after correcting for these variables. Absent such an analysis I don’t think that this study can be used to argue that there is some hidden force which is lowering the salaries of women faculty in medical schools. Certainly until more information supporting a real difference in the income of women faculty members is presented I would not invoke some nefarious mechanism. No study of women’s salaries can be complete and really useful that ignores the most important variable that affects women’s income – marital status.

Largely because of family responsibilities, women physicians concentrate on those specialties that give regular hours and more easily allow them to both practice their professions while attending to the needs of their families. These are family practice, internal medicine, obstetrics and gynecology, psychiatry, pediatrics,and dermatology. Excepting dermatology, these specialties do not pay as much as those that are more demanding of time such as trauma surgery or invasive cardiology. Women physicians and PhD scientists also are much more likely to take a break of several years from their practices. Their choice doubtless give them more personal satisfaction, but inevitably reduces their incomes.

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Highlights of Women’s Earnings in 2008 Start at page 9 or put “never” into the search field.