VIEWPOINT
Surface versus Structure: The longstanding issue of the gender pay gap in medicine
By Krystal Jacques
T
he issue of the gender pay gap is frequently forgotten by today’s society but is still pervasive across various fields of work today. A 2019 report by StatsCan revealed that Canadian women earn 0.87 cents for every dollar earned by men.1 And the gap starts early, according to a new report that tracked the earnings of Canadian post-secondary graduates across 11 fields of study (including college, bachelors, masters, and doctoral degrees). Women earned less than men in every field, with an average gap of $5,700 (12% less than men) in the 1st year after graduation, which increased to $17,000 (25% less than men) after 5 years.2 Ontario’s gender pay gap has narrowed significantly since 1987 when the provincial government first passed the Pay Equity Act. But according to a 2019 report by Glassdoor, it will take 164 years to close the gender wage gap in Canada.3 At present , jobs that mirror traditional “women’s work” (e.g. administrative, early childhood educators) tend to be undervalued because they parallel domestic work
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that women were (and are) expected to perform for free. Whether the gender pay gap exists in higher paying careers, such as medicine, is a contentious issue. According to a 2020 U.S. report, a pay gap between male and female physicians at the outset of their careers not only exists, but is actually growing.4 The starting salaries of female doctors were on average $36, 618 lower than male doctors from 1999 to 2017.4 Here, we will discuss the possible reasons for the gender pay gap in medicine-a field historically dominated by men that continues to be plagued by in-built institutional gender bias. A recently published study in JAMA Neurosurgery analyzed 1.5 million surgical procedures from the start of 2014 through 2016; it found female surgeons in Ontario earn 24% less than their male counterparts, and the proportion of women performing an operation decreased as the pay per hour for that procedure increased.5 A similar article by the Association of American Medical Colleges (AAMC) summarizing gender-based pay disparities in medicine from several resources in the Unities States (U.S.) was published a few months earlier.
These articles bring into awareness the many possible reasons for why this gender pay gap is occurring: 1) women tend to have less aggressive billing behaviours than men, 2) men tend to refuse the less lucrative medical procedures, while women tend to say yes to any opportunity they can get, 3) female physicians tend not to self-promote or negotiate salary, and 4) women tend to choose the lower paying, less lucrative specialties after their training (i.e. Gynecology).5,6 Out of all female surgeons in Ontario included in the analysis, 49% of them practiced gynecology.7 In the U.S., the percentage of female surgeons working in gynecology versus the more lucrative urology is 54% and 8% respectively.6 According to AAMC specialty data, 63% of pediatricians in the U.S. are women, whereas 95% of orthopedic surgeons are men. Also, the majority of neurosurgeons are men.5 On the surface, women tend to be less aggressive than men when it comes to self-promotion, negotiation for higher salary, getting the biggest bang for their hours, and choosing the highest paying specialties.
