The gender pay gap for physicians may be even bigger than previously thought, according to an analysis from the Doximity social network.
In a report released Wednesday morning, Doximity said that on average, women doctors earned $91,284 less than their male counterparts in annual pay.
The figures came from self-reported compensation for 36,000 of Doximity's verified licensed physicians who reported they practiced at least 40 hours per week and were reported for 2014 to 2017.
"One of the surprising things is that for all geographies and specialties, we find that women make less than men, an average of 27% difference," said report author Christopher Whaley, of the RAND Corporation and the University of California Berkeley.
That's "even after controlling for things like specialty, where they practice, the number of hours per week they work and the amount of time they've been practicing medicine."
Doximity's national average figures reflected adjustments for a variety of factors including region, specialty, length of time practicing, and weekly hours worked. Responses in the survey did not specify whether income was for patient care versus research, consulting or other non-patient care tasks.
The report detailed large annual gender gaps in each of 48 specialties. For example, female neurosurgeons earned $92,918 less than their male counterparts while female thoracic surgeons earned $81,594 less and vascular surgeons, $88,800 less. Gaps were smaller but still significant for primary care, such as $41,771 less for internal medicine doctors and $42,555 for family practice physicians.
In every specialty, the average male physician was paid more than the average female, the report said.
This survey showed much larger gaps than those reported last July in a JAMA Internal Medicine study, which found women in U.S. public medical schools earning nearly $51,000 less than male peers -- closer to $20,00 after adjusting for a variety of factors.
In this Doximity analysis, other big dollar differences were in gastroenterology, where female doctors made $78,490 less; dermatology, $76,692 less; cardiology, $75,783 less; and otolaryngology, $71,165 less.
The pay disparity persisted when male and female physicians' income was compared in the same cities and states.
Women made less than men in all 50 metropolitan areas in the survey, with the biggest gaps in the Charlotte, N.C. metropolitan area, where women physicians made $125,035 dollars less than men, or 67% less.
"In no metro area do women make more than men," Whaley said. In Charlotte, women made a reported $125,000 less than men across various specialty practices; in Bridgeport, Conn, $111,000 less, in Orlando, $108,000 less and in Louisville, Ky and in Houston, $106,000 less.
The report said female physicians were paid the most in Minneapolis and Phoenix, where they reportedly earned an average of $290,000 a year. At the low end was Durham, N.C., where they received $205,635. And in every city they didn't make as much as their male colleagues.
The Doximity report would not speculate on reasons for the gaps. But Whaley noted that some studies see more women entering academic medicine, which may pay some doctors less. "There also might be differences in how men and women negotiate for salaries."
Price Paid for Caring?
Travis Singleton, senior vice president of Merritt Hawkins, the largest physician recruitment firm in the nation, denied that women doctors are systematically underpaid relative to men. Rather, he said, it's an issue of how much work they do in the same amount of time, and that's not always reflected a simple count of how many hours they work.
"The reality is we don't see any discernible difference between offers to females or male candidates," he said.
What does differ, he said, is the number of patients seen by female versus male doctors in a given time period.
"Many studies show that female physicians tend to spend more time with each patient, and that ... means probably less RVUs [relative value units] and their compensation will probably be less."
He noted that in the 2016 Survey of America's Physicians, conducted by Merritt Hawkins, female physicians were seeing 9.2% fewer patients per day than male physicians. That productivity difference likely influences the formula that determines their compensation, he said.
Singleton added that spending more time with their patients may mean they are giving better care and making their patients happier -- but that "could inhibit the income of female physicians in productivity-based compensation formulas."
On the other hand, Lynda Kabbash, MD, chair of the governing council of the American Medical Association's Women's Section, which represents 72,000 women doctors, said the JAMA Internal Medicine study, which corrected for those work practice variables, proved there is a significant gender gap and that the Doximity report may reflect a larger problem. "The pay gap is much more than a matter of RVUs," she said.
What's probably more to blame, she said, is the failure of women to hone their bargaining skills. "Women don't have the same inclination to promote themselves or seek recognition for what they've achieved compared to a man. And that translates to a paucity of women in leadership positions, whether in the academic or hospital environment."
"Salary is often not the priority for women that it should be."
Suzanne Harrison, MD., president of the American Medical Women's Association, with 4,000 physicians, concurred. "We're not trained to negotiate our salaries and benefits like the boys are trained to do," she said.
Singleton views it differently. "I flat out don't see that at all," he said. Rather, they negotiate, often with legal representation, and full knowledge of comparative compensation programs. Women in leadership "tend to command more (compensation) than males."
Other Survey Findings
The Doximity survey also confirmed vast geographic disparities in pay scales, apart from gender. Across all physician specialties, the average stood at $297,700 in Cincinnati compared with $359,455 in Charlotte, N.C.
Physicians in upper Midwestern states of North Dakota, South Dakota, Idaho, Nebraska, Wisconsin, Wyoming and Montana reported receiving more than physicians in any other states, between $351,682 and $410,461, compared to $278,960 for doctors in the District of Columbia.
Singleton said that's because it's harder to recruit doctors to practice in those more rural areas as opposed to more urbanized coastal regions like Massachusetts, where doctors are easier to find. So they have to be paid more.
"Nebraska is famous for this," he said. "If you get down to Scottsbluff and Valentine and some of those areas like McCook, it's going to be very difficult to justify full time specialists, and in some cases a primary care physician." So doctors are recruited to drive from town to town, or they buy a plane and learn to fly. "There's a certain premium put on doing that," Singleton said.
Singleton said with 36,000 respondents, the Doximity report represents a significant data set. But he cautioned that what doctors submitted to it may not be that reliable.
"Doctors may not really know what they are being asked. Or they may be putting what they wish they could make if they were looking for a job," he said. A more accurate report would capture what doctors actually made at the end of the year, specifying whether it excludes practice reinvestments, bonuses, or incentive payments. "Compensation packages have gotten very complex," he said.