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Women may now equal or outnumber men in medical school classes, but their lifetime earnings as doctors still fall far short of parity. A persistent 25% pay gap between female and male physicians adds up to $2 million over a medical career, a new analysis calculates, after accounting for specialty, hours, location, and years of experience.

The study, published Monday in Health Affairs, echoes other research in academic medicine but also charts a similar gulf in community settings. Its authors believe their work is the first to put a dollar sign on the cumulative impact on income for physicians wherever they practice.

To arrive at their figures, researchers from the RAND Corporation, the physician network Doximity, and U.S. medical schools analyzed salary data from Doximity for more than 80,000 full-time physicians from 2014 through 2019. Their model found that male physicians make $2,043,881, or 25%, more than female physicians over the course of a simulated 40-year career.

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Health Affairs physician salary gap

“We’ve asked physicians to do a lot during the pandemic,” study co-author Vineet Arora, dean for medical education at University of Chicago Pritzker School of Medicine and an internal medicine physician, said in an interview. “You’ve done all of that and you’re a woman and you find out now that you’re not getting what you’re worth? It’s not necessarily the dollar amount. It’s the inequity. That’s the problem.”

Doctors are no exception to the pandemic trend of women bearing more of the burden than men when it comes to child care, schooling, and sacrificing careers to family needs, according to a recent JAMA Network Open study. The disparity in income will only grow, Esther Choo, an emergency physician and professor at Oregon Health & Science University, told STAT.

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“I am confident that the gender salary gap will widen — in this year’s Doximity compensation report, you can already see that 2020 was worse than 2019,” said Choo, who was not involved in the Health Affairs or JAMA Network Open studies. “I think it was partially due to how domestic roles are distributed societally, but also due to gendered ways in which resources, roles, power, and career opportunities opened up for women vs. men in this time.”

Some specialties had wider gaps than others: Primary care had the lowest income difference, at $917,851, and surgical specialties had the highest, at $2,481,622. Arora pointed out that previous research has suggested female physicians might be less likely to go into higher-paying specialties and more likely to serve in lower-paying but more mission-driven work, such as primary care, amounting to a double hit on salary.

The gap starts early, at about $20,000 in the first year of practice for primary care and for specialities. Then the divide gets only wider, meaning women never catch up. That’s important when many physicians are paying off debt from medical school tuition, Arora said. Right now, she said, 80% of medical students come from the top two of five income brackets.

“As we work to diversify the types of students that come to medical school from not just groups that are underrepresented in medicine, but those that are from lower income quintiles, it’s really important for us to think about salary and really about income long term and educational debt,” she said. “Medical education is incredibly expensive.”

Doctors outside academic medical centers have other bills to pay, too. “Being in the community, it’s not just that you have to provide for your family,” Arora said. “If you’re part of a group practice, you also have to also keep the lights on.”

So what can be done?

Employers in academic or community settings could even out starting compensation, commit to correcting gaps when they are found, and restore lost compensation, Choo said.

“If a difference occurs at the outset, the compensation paths start to diverge immediately. It also sends a message about differential value from the outset and signals different investment in and commitment to candidates based on gender,” she said. “The notion that balanced representation will take care of pay inequity is really dispelled by the persistent gender gaps in fields like OB-GYN and pediatrics, which are majority women.”

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