What does your doctor look like, and how much is she paid?

Feb 03 2011 Published by under Medicine

Not to be a nudge, but you could vote for me for a Medgadget Medical Weblog Award in one (or both, presumably) of two categories: Best Medical Blog, or Best Literary Medical Blog.  Voting will be open for another ten days.

A real doctor?

Currently, over 48% of medical school graduates are women.  Seven percent of medical school students are African American.  About 8% report Hispanic or Latino ethnicity.  So, while medical school classes increasingly look like a typical suburban high school in my part of the country, they do not look much like the US population at large.  If you grow up in a Hispanic community and speak Spanish, you may have a hard time finding a doctor who speaks your language.  If you are African American, you may have a hard time finding a doctor with potentially similar experiences to yours, and finding an empathic, understanding doctor is already difficult enough.  Some of this is mitigated by the possibility that ethnic minority doctors may choose to practice in ethnic minority neighborhoods, but this has its own difficulties, including salary differences.

A newly released study reports on a significant disgrace in medicine, one which sheds some light on salary disparities in medicine.  This study found the gender gap for starting physicians' salaries is growing, with new male physicians averaging nearly $17,000 more annually than new female physicians in 2008.   This was a significant rise from the late 1990's when the gap was only about $3000, much of which disappeared when controlled for significant variables.

The gender gap in doctors' pay has been studied in the past, and has often been attributed to women working few hours, or choosing lower paying specialties, such as primary care.  But during the time of the study, women increasingly shunned primary care in favor of higher paid specialties.  Family status, although not followed explicitly, seemed a poor explanation, as the study looked only at starting salaries, and previous studies showed only small effects of family status.  This data would have been nice, but is it truly relevant?

When looking at pay discrimination, there are always multiple factors that can be used to "explain" gender differences in pay.  Do women physician, when looking for their first job, offer to work less in order to raise a family they may or may not have?  Or do potential employers simply assume that women doctors will not work as much as men?  Or does our society simply put a lesser value on women as highly-trained professionals, and paint over this judgement with various and interchangeable excuses?

The gender ratio in medicine is rapidly approaching parity, and may exceed it soon.  As more women practice medicine, will the profession become ghettoized?  Will we feel even more comfortable balancing our health budget on the backs of physicians?

That's a lot of questions without answers, but the gap is growing, and we can no longer feign ignorance.

References

Lo Sasso, A., Richards, M., Chou, C., & Gerber, S. (2011). The $16,819 Pay Gap For Newly Trained Physicians: The Unexplained Trend Of Men Earning More Than Women Health Affairs, 30 (2), 193-201 DOI: 10.1377/hlthaff.2010.0597

21 responses so far

  • Melissa G says:

    My internist is an African-American man, my psychiatrist is an African-American woman, and my boy's pediatrician is a white woman in a practice with several other women, one of whom is Hispanic.

    But as to compensation, I greatly suspect that of this lot, the man gets paid most. He's in a prestigious regional clinic, whereas the women on my small list are all in private practice-- though the pediatricians have hospital privs at Large Regional Medical Center next door to them, so I am guessing they're making more than the psychiatrist in solo practice.

    It does make me wonder whether our son's band of female pediatricians went into practice together because of pay disparity considerations.

  • Mary says:

    Interesting question for me. My doctor's a tranny. She's awesome. But I'll bet in a very very small group....

  • I don't think I've ever had an ethnic minority doctor. Geographic Isolation and all that. My OB and our pediatrician are both women, and whatever they're paid, I'm sure it's not fair compensation for the level of quality and compassionate care we receive.

  • Alexis says:

    I don't have any firm answers, but from my outsider's POV, it seems like increased female representation and low prestige specialties are tied together--and prestige only declines as the specialty comes to be female dominated. OB/GYN comes to mind. Even within OB/GYN, I've noticed that younger generalists skew female, but the percentage of men is higher in the better paid subspecialties (RE, MFM, gyn-onc). Maybe this will start slipping in a few years. If my local teaching hospital is any indication, OB/GYN is almost all female. (I saw the resident photo sheet: 21/24 female.)

    For general internal medicine and FP, IMGs are more noticeable than women. I don't live in an particularly diverse area, but I've noticed a lot of internists with south Asian names--including my own.

  • Isabel says:

    "So, while medical school classes increasingly look like a typical suburban high school in my part of the country, they do not look much like the US population at large."

    What is increasing? Are you saying they are becoming more white? They are undoubtedly becoming more Asian, which doesn't reflect most suburban high schools I am familiar with.

    • PalMD says:

      I'm not sure whether I failed to express myself more clearly or you failed to read carefully. Med school classes used to be overwhelmingly white and male. The proportion of women and African Americans has grown, but not so much Latinos and other under-represented minorities. The crack about Asians has some purpose I assume.

      My part of the country has a smaller Hispanic population than most, so these classes tend to look like a suburban HS in my part of the country.

      • Isabel says:

        Why do you call my question a crack? It was an honest question. You should have expressed yourself more clearly. Why make sweeping generalizations that are not actually true, when you can be more specific (in this case, "In terms of proportion of women and Hispanics, med schools are looking more like my suburban neighborhood".

        I know you were leading into a post about woman doctors, but your summary of the overall situation felt trite and it seemed almost weird to leave out the fastest growing ethnic group, or race, that actually numbers much higher than blacks and Hispanics combined. And what about the socio-economic class background of the graduates? Does it look like America, or only the rich suburbs? If you are a working class white woman will you " have a hard time finding a doctor with potentially similar experiences to yours" ?

        • PalMD says:

          Perhaps you should consider starting your own blog?

          • Dude, all those Asian medical students are stealing spots from underprivileged rednecks! And Loonabel does have her own blogge:

            http://physioprof.wordpress.com

            It's one of the few places on the Internet she hasn't been banned from!

          • Isabel says:

            Why would you make such an ignorant, offensive comment "Comrade" (what a joke) Physioprof?

            Oh that's right, you are a tool of the oligarchy. You must sow dissension at every opportunity.

            And you must make it look like someone else is doing it (in this case putting the foul words, which *I* would never say, in my mouth).

            Smooth, dude.

          • Isabel says:

            Why would I want to start my own blog? I'm only wondering why you need to cherry pic the data.

            "comrade" PP I am banned from exactly two blogs. That is not why I post from your blog.

          • Isabel says:

            I'm not accusing anyone of stealing spots from anyone. I am just talking about reality, dude.

        • Funky Fresh says:

          Yeah! Fuck those brown folks getting in to medical school. They don't count. They're all the rich ones and they are taking spots from poor whitey.

          • Isabel says:

            Don't count for what? What are you talking about?

          • Funky Fresh says:

            The brown people in medical school aren't even real brown people. They're all upper class. Everyone knows that lower class white people are discriminated against. Not upper class brown people. There's even some book about it on Amazon and everything.

          • Isabel says:

            Sure Funky, whatever you say.

            The whole point of my comment was 1. Med schools do not increasingly look like typical American suburbs (so why say that? that is really the interesting question) and 2. socioeconomic diversity needs to be addressed especially when we are making comparisons between institutions and the greater society.

            It's funny how you and Pal think a doctor from the white upper middle class is going to automatically understand the life of a working class white patient and the patient will automatically feel comfortable and identify with the doctor because they have similar color skin, that this is only an issue for 'ethnic' patients or something. Someone sensitive to class disparities would know that this is not true.

  • theshortearedowl says:

    Women may be better represented in some of the higher paying specialties, but it seems like the surgeons - especially the specialties like neuro - still have a very boys club mentality. My guess is a lot of the disparity lies here.

  • skeptifem says:

    The fact that women make up such a high percentage of med school graduates is constantly held up as evidence that discrimination is gone. Ha.

  • [...] no secret that doctors don't often look like their patients.  This simplistic observation hides a more complex set of effects: in addition to the economic [...]

  • [...] written before about many of the challenges faced by women in medicine.  As more and more women enter medicine, there is a cultural shift struggling to be born.  In the early 1960's, about 5% of medical [...]

  • Dustin says:

    Affirmative action is already largely in favor of women and under-represented minorities (compare the admission statistics of Howard, Meharry, and Morehouse medical schools to other schools). This may create less competitive doctors, which would affect the future of medicine especially in surgery. Remember that women and URM do not necessary favor women and URM in their practice (a good proportion still follow where the money flows).