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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.
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.
Despite this salary equity, we investigated potential disparities in other forms of currency in academic medicine.
The distribution of current leadership positions, current academic rank, and protected time over the past 12 quarters (3 years) in the Department of Emergency Medicine was analyzed. Leadership positions were obtained from curriculum vitae; academic rank was obtained from the promotions committee; and protected time was obtained from confidential administrative data. Protected time was measured as a percentage of a full time equivalent and as a binary variable.
The well-known underrepresentation of women in emergency medicine was illustrated in our departmental data, with only 14 of 42 female full-time faculty (33%). We found no significant difference in titled leadership positions (P=.26) between 50.0% women (n=7 of 14) and 68% men (n=19 of 28) or in the distribution of academic rank (clinical instructor, assistant professor, associate professor, and full professor) relative to the ratio of men to women in the department, with 29% of women (n=4 of 14) and 21% of men (n=6 of 28) holding a rank of associate professor or full professor (P=.61).
We found that male physicians were more likely to have any protected time than women for the first 7 years of tenure (see Figure 1). The difference was statistically significant for the first 1.5 years of tenure, with the difference ranging from 40 to 46 percentage points; for example, a male’s probability of having any protected time in the first quarter was 96% (95% CI, 92.3% to 100%) while a female’s probability was 51% (95% CI, 42.0% to 59.5%). Women caught up after 7 years tenure. In a second analysis, we specified a similar model of protected time estimating gender-specific effects for tenure (ie, time in the department) and tenure squared (to allow for nonlinear trends) and specifying a random intercept for each physician. Within our small sample sizes, we saw clinically large, but not statistically significant, differences in protected time (see Figure 2).
Figure 1Proportion of physicians with any protected time by gender. Female physicians are represented in blue and men are represented in green; bars indicate 95% CIs.
Figure 2Proportion of full time equivalent that is protected time by gender. Female physicians are represented in blue and men are represented in green; bars indicate 95% CIs.
Although we did not find differences in academic rank or leadership positions between men and women, we found that men were more likely to have any protected time than women in the first 1.5 years and that women caught up with men in both the proportion of protected time and the probability of having any protected time at about 7 years of tenure.
Salary equity has been proposed as a solution for the gender pay gap, but when striving to achieve gender equity, there are other forms of currency that should be considered.
References
Hayes S.N.
Noseworthy J.H.
Farrugia G.
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.
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.
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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