How Healthy is the State of Women in Medicine?

Let’s start with some numbers.

In a 2011 Health Affairs Article, LoSasso et al concluded, “In 2008, male physicians newly trained in New York State made on average $16,819 more than newly trained female physicians, compared to a $3,600 difference in 1999.”

A 2013 study in Academic Medicine re-examined the pay gap for new doctors to see if the trend had changed, but unfortunately they reached a similar conclusion as the 2011 study.  The authors wrote, “….we observed a substantial gender difference in salary that was not fully explained by specialty, academic rank, work hours, or even spousal employment. These findings suggest that salary disparities in academic medicine exist even in cohorts hired recently and that these disparities arise early in the course of a career.”

In academic medicine, the situation of women in leadership positions raises further concerns.  The Association of American Medical Colleges assembled some key numbers concerning women in academic medicine using the 2013-1014 data.  Academic medicine, as their data shows, is dominated by men.  Only 15% of department chairs are women, while 22% of tenured professors are women and 21% of full professors are women.

Carr et al in the journal of Women’s Health interviewed women at 24 randomly selected medical schools affiliated to the two major professional associations focused on diversity and inclusion in medicine.  While these interviews are less generalizable, the comments were incisive, and correspond with informal thoughts and conversations Doctors Council members have shared.  For example:

“At the most senior level, [it’s] essentially an old boys’ club…. The large critical mass is still a bunch of white guys.”

“We have a large number of women in leadership positions, but that doesn’t mean that we have achieved equity…as you get farther and farther along…it gets more and more difficult…you’re dealing with subtler and subtler issues.”

“If you happen to get a chairman who has no interest in promoting women, there really have been …no consequences for that.”

The question of culture has also been examined in the literature. A study in the 2013 Journal of General Internal Medicine analyzed a stratified random sample of 4,7578 full time faculty at 26 medical colleges.  The authors wrote:

“The central finding of this study is that male and female faculty have equal feelings of being engaged and enthusiastic about their work and have equal leadership aspirations, yet women faculty do not feel as confident about career advancement as men, do not feel equally included in the environment of academia, and their personal values are more likely to be at odds with institutional values. “

A 2014 Study in Academic medicine went a step further and argued for the importance of supportive culture. The authors wrote:

“Our findings provide consistent and strong support for the critical role of the culture of the department/division on women’s careers. A supportive work culture appears to buffer women from the negative impact of both work overload and long work hours on levels of work-to-family conflict.”

Pay inequity, leadership inequity and lack of cultural support all remain problems for women doctors.