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A Structured Compensation Plan Results in Equitable Physician Compensation

A Single-Center Analysis



      To assess adherence to and individual or systematic deviations from predicted physician compensation by gender or race/ethnicity at a large academic medical center that uses a salary-only structured compensation model incorporating national benchmarks and clear standardized pay steps and increments.

      Participants and Methods

      All permanent staff physicians employed at Mayo Clinic medical practices in Minnesota, Arizona, and Florida who served in clinical roles as of January 2017. Each physician’s pay, demographics, specialty, full-time equivalent status, benchmark pay for the specialty, leadership role(s), and other factors that may influence compensation within the plan were collected and analyzed. For each individual, the natural log of pay was used to determine predicted pay and 95% CI based on the structured compensation plan, compared with their actual salary.


      Among 2845 physicians (861 women, 722 nonwhites), pay equity was affirmed in 96% (n=2730). Of the 80 physicians (2.8%) with higher and 35 (1.2%) with lower than predicted pay, there was no interaction with gender or race/ethnicity. More men (31.4%; 623 of 1984) than women (15.9%; 137 of 861) held or had held a compensable leadership position. More men (34.7%; 688 of 1984) than women (20.5%; 177 of 861) were represented in the most highly compensated specialties.


      A structured compensation model was successfully applied to all physicians at a multisite large academic medical system and resulted in pay equity. However, achieving overall gender pay equality will only be fully realized when women achieve parity in the ranks of the most highly compensated specialties and in leadership roles.

      Abbreviations and Acronyms:

      ACC (American College of Cardiology), FTE (full-time equivalent)
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        • Asgari M.M.
        • Carr P.L.
        • Bates C.K.
        Closing the gender wage gap and achieving professional equity in medicine.
        JAMA. 2019; 321: 1665-1666
        • DesRoches C.M.
        • Zinner D.E.
        • Rao S.R.
        • Iezzoni L.I.
        • Campbell E.G.
        Activities, productivity, and compensation of men and women in the life sciences.
        Acad Med. 2010; 85: 631-639
        • Lo Sasso A.T.
        • Richards M.R.
        • Chou C.F.
        • Gerber S.E.
        The $16,819 pay gap for newly trained physicians: the unexplained trend of men earning more than women.
        Health Aff (Millwood). 2011; 30: 193-201
        • Jagsi R.
        • Griffith K.A.
        • Stewart A.
        • Sambuco D.
        • DeCastro R.
        • Ubel P.A.
        Gender differences in the salaries of physician researchers.
        JAMA. 2012; 307: 2410-2417
        • Freund K.M.
        • Raj A.
        • Kaplan S.E.
        • et al.
        Inequities in academic compensation by gender: a follow-up to the National Faculty Survey Cohort Study.
        Acad Med. 2016; 91: 1068-1073
        • Jena A.B.
        • Olenski A.R.
        • Blumenthal D.M.
        Sex differences in physician salary in US public medical schools.
        JAMA Intern Med. 2016; 176: 1294-1304
        • Spencer E.S.
        • Deal A.M.
        • Pruthi N.R.
        • et al.
        Gender differences in compensation, job satisfaction and other practice patterns in urology.
        J Urol. 2016; 195: 450-455
        • Strategic Health Care
        2018 Physician Compensation Report.
        • Medscape
        Medscape Physician Compensation Report 2019. Medscape.
        • Read S.
        • Butkus R.
        • Weissman A.
        • Moyer D.V.
        Compensation disparities by gender in internal medicine.
        Ann Intern Med. 2018; 169: 658-661
        • Saunders M.R.
        • Turner B.J.
        Unequal pay for equal work: where are we now?.
        Ann Intern Med. 2018; 169: 654-655
        • Shah R.U.
        The $2.5 million dollar wage gap in cardiology.
        JAMA Cardiol. 2018; 3: 674-676
        • Weeks W.B.
        • Wallace T.A.
        • Wallace A.E.
        How do race and sex affect the earnings of primary care physicians?.
        Health Aff (Millwood). 2009; 28: 557-566
        • Madsen T.E.
        • Linden J.A.
        • Rounds K.
        • et al.
        Current status of gender and racial/ethnic disparities among academic emergency medicine physicians.
        Acad Emerg Med. 2017; 24: 1182-1192
        • Butkus R.
        • Serchen J.
        • Moyer D.V.
        • Bornstein S.S.
        • Hingle S.T.
        • Health and Public Policy Committee of the American College of Physicians
        Achieving gender equity in physician compensation and career advancement: a position paper of the American College of Physicians.
        Ann Intern Med. 2018; 168: 721-723
        • National Academies of Sciences, Engineering, and Medicine
        Sexual Harrassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine.
        The National Academies Press, Washington, DC2018
        • Association of Women Surgeons
        Statement on gender salary equity. 2018.
        • O’Reilly Kevin B.
        Physicians adopt plan to combat pay gap in medicine. 2018 AMA Annual Meeting Web site.
        (Published 2018)
        • Douglas S.
        • Cathleen Biga
        • Kristin M.
        • et al.
        2019 ACC health policy statement on cardiologist compensation and opportunity equity.
        J Am Coll Cardiol. 2019; 74: 1947-1965
      1. Time's Up Healthcare.
        (Published 2019. Accessed Oct 12, 2019)
        • Teixeira-Poit S.M.
        • Halpern M.T.
        • Kane H.L.
        • Keating M.
        • Olmsted M.
        Factors influencing professional life satisfaction among neurologists.
        BMC Health Serv Res. 2017; 17: 409
        • Menacker M.
        Physician compensation methodology must change!.
        Am J Med. 2019; 132: 554-555
        • Morris M.
        • Chen H.
        • Heslin M.J.
        • Krontiras H.
        A structured compensation plan improves but does not erase the sex pay gap in surgery.
        Ann Surg. 2018; 268: 442-448
        • Berkeley Vice Provost for the Faculty
        UC Berkeley Faculty Salary Equity Study, Annual Update 2018.
        • Goldin C.
        A grand gender convergence: it's last chapter.
        Am Econ Rev. 2014; 104: 1091-1119
        • Robbins C.
        Salesforce blog. 2018 Salesforce Equal Pay Assessment Update.
        (Published April 17, 2018) (Accessed May 2, 2019)
        • Hlatky M.A.
        • Shaw L.J.
        Women in cardiology very few, different work, different pay.
        J Am Coll Cardiol. 2016; 67: 542-544
        • Trowbridge E.
        • Bartels C.M.
        • Koslov S.
        • Kamnetz S.
        • Pandhi N.
        Development and impact of a novel academic primary care compensation model.
        J Gen Intern Med. 2015; 30: 1865-1870
        • Westring A.
        • McDonald J.
        • Carr P.
        • Grisso J.
        An integrated framework for gender equity in academic medicine.
        Acad Med. 2016; 91: 1041-1044
        • Leverence R.
        • Nuttall R.
        • Palmer R.
        • et al.
        Using organizational philosophy to create a self-sustaining compensation plan without harming academic missions.
        Acad Med. 2017; 92: 1133-1137
        • Sanfey H.
        • Crandall M.
        • Shaughnessy E.
        • et al.
        Strategies for identifying and closing the gender salary gap in surgery.
        J Am Coll Surg. 2017; 225: 333-338
        • Khullar D.
        • Kocher R.
        • Conway P.
        • Rajkumar R.
        How 10 leading health systems pay their doctors.
        Healthc (Amst). 2015; 3: 60-62
        • Moss-Racusin C.A.
        • Dovidio J.F.
        • Brescoll V.L.
        • Graham M.J.
        • Handelsman J.
        Science faculty's subtle gender biases favor male students.
        Proc Natl Acad Sci U S A. 2012; 109: 16474-16479
        • Correll S.
        • Benard S.
        • Paik I.
        Getting a job: is there a motherhood penalty?.
        Am J Sociol. 2007; 112: 1297-1339
        • Association of American Medical Colleges
        2018 Physician Specialty Data Report.
        • Jagsi R.
        • Biga C.
        • Poppas A.
        • et al.
        Work activities and compensation of male and female cardiologists.
        J Am Coll Cardiol. 2016; 67: 529-541
        • Greenberg C.C.
        Association for Academic Surgery presidential address: sticky floors and glass ceilings.
        J Surg Res. 2017; 219: ix-xviii
        • Bertrand M.
        • Mullainathan S.
        Are Emily and Greg more employable than Lakisha and Jamal? A field experiment on labor market discrimination.
        Am Econ Rev. 2004; 94: 991-1013
        • Carnes M.
        • Devine P.G.
        • Baier Manwell L.
        • et al.
        The effect of an intervention to break the gender bias habit for faculty at one institution: a cluster randomized, controlled trial.
        Acad Med. 2015; 90: 221-230
        • Croson R.
        • Gneezy U.
        Gender differences in preferences.
        J Econ Lit. 2009; 47: 448-474
        • Bertrand M.
        New perspectives on gender.
        in: Card D. Ashenfelter O. Handbook of Labor Economics. Vol. 4, Part B. Elsevier, Philadelphia, PA2011: 1543-1590
        • Bowles H.R.
        Why women don't negotiate their job offers. Harv Bus Rev.
        (Published June 19, 2014)
        • Mazei J.
        • Huffmeier J.
        • Freund P.A.
        • Stuhlmacher A.F.
        • Bilke L.
        • Hertel G.
        A meta-analysis on gender differences in negotiation outcomes and their moderators.
        Psychol Bull. 2015; 141: 85-104

      Linked Article

      • Physician Equity II
        Mayo Clinic ProceedingsVol. 95Issue 5
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          We read with interest the article by Hayes et al.1 The gender pay gap is a well-traveled narrative in many professions, including academic medicine, in which the average male physician earns almost $12,000 more than their female counterparts even after adjusting for tenure, rank, years at rank, and clinical duties.2 As explained in the article, unlike many academic medical centers, Mayo Clinic compensates physicians according to an equitable stepwise salary progression model over a 5-year period, with the maximum target compensation based on specialty and the number of years postresidency.
        • Full-Text
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      • Physician Equity I
        Mayo Clinic ProceedingsVol. 95Issue 5
        • Preview
          Differences in compensation between male and female physicians are persistent, and the reasons for these differences are not fully understood.1 Hayes et al2 reported the potential for a structured, salary-only plan to achieve equitable compensation in an academic medical system. They concluded that overall gender pay equality—across practice settings and specialties—will require that women are proportionally represented in highly compensated specialties as well as leadership roles in medicine.
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      • In reply—Physician Equity I and II
        Mayo Clinic ProceedingsVol. 95Issue 5
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          We appreciate the comments and analysis provided by Lifton,1 who found that among most member boards of the American Board of Medical Specialties, gender composition of the directors closely matched, and in a number of cases exceeded, the representation of women in active practice in the specialty. Arguably, and a point made in the cited Walker et al reference,2 a better goal might be “overrepresentation” of women directors so as to be more representative of the near-future workforce and closer to the proportion of women in training.
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