Introduction It's no secret that female physicians earn less than their male counterparts, and that the problem has persisted for many years, despite the fact that women are entering medicine in greater and greater numbers. Even after specialty and other workforce factors that have long been cited as reasons for the pay gap are controlled for, research shows that female doctors earn less than their male peers. Although the factors contributing to the wage gap may be myriad and subtle, one possibility that has gained both traction and opposition is that female physicians simply may not negotiate as well as men. Mind the Gap Female physicians have heard the old saw a thousand times: They earn less than male doctors because they're more likely to go into primary care rather than the more lucrative subspecialties. According to the 2015 Medscape Physician Compensation Report, employed male physicians earn nearly 23% more than their female counterparts ($249,000 vs $203,000 annually). Fewer women also reported working in high-paying specialties, such as gastroenterology, cardiology, orthopedics, and urology.[1] But as a study published in the February 2011 issue of Health Affairs[2] demonstrated, those factors don't fully explain the pay gap. The study set out to explore the pay gap by making an apples-to-apples comparison of starting salaries among newly trained physicians in New York state over a 10-year period. After controlling for specialty type, hours worked, and other characteristics, researchers found not only that female physicians earned less, but the discrepancy was getting worse, growing from an average $3600 gap in 1999 to a $16,819 differential in 2008. Anthony Lo Sasso, PhD, a professor of health policy and administration at the University of Illinois at Chicago and the lead author on the Health Affairs study, says one possible explanation is that female physicians may prefer compensation packages that emphasize nonmonetary benefits. If that's the case, he says, female physicians may be "voting with their feet" and choosing employers on the basis of family considerations or advancement potential, rather than those that offer richer compensation packages. Hogwash, says Theresa Rohr-Kirchgraber, MD, president of the American Medical Women's Association (AMWA) and executive director of Indiana University's National Center of Excellence in Women's Health. Dr Rohr-Kirchgraber cites Lo Sasso's study as evidence the system discriminates against women and that female physicians—far from getting what they want out of the hiring process—are settling for lower wages in part because they lack the information or training to negotiate effectively. Ask for It! Linda Babcock, an economics professor at Carnegie Mellon University in Pittsburgh, has coauthored several books on negotiation and the gender divide. She says a key problem is that women, unlike men, don't ask for what they want. She cites data indicating that men initiate negotiations about four times more often than women and are more likely to describe the negotiating process as "winning a ball game" or "a wrestling match," whereas women are more likely to equate it with "going to the dentist."[3] Perhaps not surprisingly, female physicians were less likely than male MDs and DOs—by an 8%-11% margin—to say that "making good money" is the most rewarding aspect of their job, according to Medscape's latest compensation report. Women are likewise more pessimistic about what they can achieve through negotiations and ask for far less than men do. The result: On average, even when women negotiate, they receive 30% less than men. That's a mistake that can have huge financial ramifications over time. By not negotiating hard for a good initial salary, an individual stands to lose more than $500,000 by age 60 years, Babcock says. The idea that the negotiating process puts women at a disadvantage has gained such traction that Ellen Pao, former CEO of the online message board Reddit, banned salary negotiations in an attempt to tackle gender-based pay disparities. In April, 2015, Pao told the Wall Street Journal, "Men negotiate harder than women do, and sometimes women get penalized when they do negotiate."[4] Babcock notes that women "need to be more assertive, but they do need to be careful about how they negotiate." She says research shows people don't really care how a man negotiates, but a woman who negotiates aggressively is often perceived to be difficult, which can negatively affect her future within the organization. Babcock advises women to: Aim high. Identify the most you're likely to achieve in terms of pay and benefits and the least you're willing to accept. Set targets that are ambitious but realistic, and know what your best alternative is if negotiations fail. Do your research. Talk to friends; search the Internet; and use connections, such as alumnae associations and professional organizations, to learn the going rate for someone with your experience and training. Benchmarking compensation within your organization can be tricky, Babcock says, but not impossible. "You're not going to go to your supervisor and ask, 'What do Drs X, Y, and Z make?' but you can say, 'There are 10 pediatricians in this practice. Can you tell me in which quartile I fall?'" Bargain cooperatively. Identify common goals and keep the other person's perspective and constraints in mind. Work to achieve a win/win situation. "Ask yourself, 'How can I reduce the constraints on their side? What can I bring to the table that's going to make them think this is a good exchange?'" Negotiate everything. Money isn't the only issue on the table. Bargaining for other perks—including resources, a better schedule, extra vacation days, job title, and training opportunities—can help you land a better offer while negotiating collaboratively. Practice. Babcock advises her economics students to practice making small requests and negotiating with a wide array of people before gradually working toward an important and meaningful exchange. Role-playing, which includes dress rehearsals, debriefings, and repetition, will help build your confidence, improve your skills, and refine your strategy. AMWA considers negotiating such an important component in closing the pay gap that it prefaced its annual meeting in April with a 1-day conference on negotiating and career development. The session was such a success that AMWA intends to offer it annually and create a webinar based on the negotiating component, Dr Rohr-Kirchgraber says. Perpetuating Stereotypes? Although negotiating skills are essential for anyone to get the best compensation package possible, some worry that categorically describing women as inferior negotiators to men perpetuates yet another gender-based stereotype and, worse, misses the larger point. Mary Gatta, PhD, a sociologist and senior research scholar at Wider Opportunities for Women, a Washington, DC-based organization, says the notion that men are somehow superior negotiators perpetuates yet another gender-based stereotype. She dismisses the notion that—contrary to men—women may be negotiating for flexibility and nonmonetary benefits, "because survey data show that workplace flexibility is important to young men too." Even negotiating advocates worry that the emphasis on negotiating skills may be misplaced. "It's a distraction from the bigger issue," which is the fact that in some organizations, women are being discriminated against, says Roberta Gebhard, DO, who chairs AMWA's Gender Equity Task Force. Dr Gebhard, who describes herself as an "excellent negotiator," cites her own experience as a case in point. Several years ago, as a hospitalist with 18 years' experience, she discovered that the government facility where she was working hired a newly trained male physician for $10,000 more than she was making. She goes on to cite example after example of other female physicians who have encountered even larger discrepancies. "Do you really think a male resident has better negotiating skills than a woman who has been in the workforce for years?" Dr Lo Sasso, author of the Health Affairs study, is likewise skeptical of the role of negotiations, noting that whereas the pay gap has widened substantially in the past decade, it's unlikely that women's negotiating skills have deteriorated during that period. Righting a Wrong Although they may debate the role of negotiations, advocates for equal pay agree that the lack of institutional transparency regarding compensation is a key contributor to the pay gap. Women can arm themselves with compensation data from outside sources and industry statistics, but individuals can only do so much, Dr Gatta says. Identifying—and rectifying—gender-based pay gaps depends on transparency that can only be achieved through broader societal action. Fair-minded organizations need to conduct gender-based pay audits to understand whether they're either knowingly or inadvertently discriminating, and organizations that would willfully perpetuate discrimination need to be forced into doing so, perhaps through legislation. Improving transparency is a time-consuming and incremental process, however. In recent years, the federal Lilly Ledbetter Fair Pay Act has made it easier for people to challenge unequal pay, and a state law passed recently in Minnesota requires businesses with 40 or more employees seeking sizeable state contracts to certify that they're paying equal wages, regardless of gender. Looking forward, advocates are pushing the Paycheck Fairness Act, prospective federal legislation that would allow plaintiffs to recover compensatory and punitive damages, facilitate class-action suits, and improve the collection of pay information. But legislation isn't a panacea. AMWA has been lobbying for the Paycheck Fairness Act for years, says Dr Gebhard, but even if it's enacted, "it's just whittling away" at a deeply entrenched problem. Pay inequity is just one component of a bigger problem. Too often, she says, female physicians are allocated fewer resources and their employers undervalue their contributions, which often include high patient satisfaction scores. The problem, she says, "is about so much more than pay."[5] Does Dr Gebhard think female physicians need to be more assertive? Absolutely. But, she says, so do fair-minded male physicians. Change, she says, depends on "more women and more men of good conscience in leadership positions." Source
