Medscape is a web publication geared towards physicians. They have examined the disparity between the income difference between men and women physicians. The latter make less. This is similar to the differences in earning noted in other occupations. They issue an annual  physician compensation report. The 2019 report is here. According to their 2019 data male primary care physicians earned $258,000 to women’s $207,000; male specialists earned $372,000 to women’s $280,000. The gender pay disparity has shown up in every report since Medscape began producing it in 2011.

The Medscape investigators considered eight possible explanations for the pay differential observed. I’m paraphrasing from their summary. As can be imagined from such a charged subject they tread very gingerly. First, they concede that women physicians do more part time work than their male counterparts. So they exclude part time work from their survey.

Then they mention that more women than men go into lower paying specialties. Looking within the higher paying specialties the pay gap still persists. When they looked at age distribution the pay gap was again apparent. This analysis was necessary because it has been only recently that the number of graduating women doctors has equaled or even exceeded that of men.

The income difference still persisted whether physicians were self employed or worked for an organization. The number of hours spent seeing patients was about four hours per week greater in men which could account for some of the pay differential. Women MDs spent more time on paperwork than the male peers. Medscape speculates that this might result in better reimbursement for women partly overcoming the less time females spent with patients, but the paperwork difference was not as great as the increased time spent with patients by men physicians.

The study considered the possibility that women were less aggressive negotiators and hence might settle for lower pay. This characteristic is hard to assess and the Medscape authors don’t think it important. But it seems a guess on their part.

What about achieving an appropriate balance between work and other activities such as home and family life? “More women physicians say it’s quality of life and flexibility with their schedule. Males more often say income and control over certain aspects of their practice.”

Medscape last considers that outright gender bias might account for the income difference consistently observed. Such bias is very difficult to document. If it exists it certainly should disappear shortly given that the entering class of every medical is 50% female or more and has been so for quite some time. More women are moving into the top decision making jobs in American Medicine. Soon there should be at least as many women as men in these positions.

My own personal opinion, based on many years of observation, is that there is no gender bias now. But as extensive as my experience is, it’s still just that of one person and thus can easily be off.

Another phenomenon that might be germane to this issue is the number of women physicians, married to physicians, who have give up the practice of medicine entirely. I have no hard data about this, but every physician I know (male or female) knows several women doctors who no longer practice because they decided to concentrate on family life. They would not show up in the Medscape survey, but they could – if even subconsciously – influence personnel practices.  I have not heard a single instance of the reverse; ie, a male doctor married to a woman MD who decides to withdraw from the profession to devote his time to the needs of his family.

When you do an experiment, you try to set it such that there is only one uncontrolled variable. In addition to the factors mentioned above, other forms of bias not related to gender might play a role in pay disparity. Thomas Sowell looking at this problem suggested a way that might eliminate bias other than gender when looking at the salaries of men and women doing the same job. He looked at never married white women’s income relative to that of men’s and found that there was virtually no difference in salary going back more than a century.

Today you’d have to examine the pay of white native born, American medical school graduates, who have never been pregnant. If you could get these data in sufficient numbers and compare the incomes of these women to those of men doing similar work, you would come close to finding gender discrimination should it exist. My guess, and that’s all it is, is that the salary differential would diminish, perhaps to the vanishing point.

I’ve written about this important issue before. It’s an obvious preoccupation of those who purport to be the leaders of American Medicine. Politicians want to make use of the issue to garner votes; they tend not to be interested in facts that don’t increase their vote total. I think the best way to deal with the issue is to get the best data possible and use them to convince  people of good will to modify their behavior in ways that will eliminate both bias and intrusive rule making.