Dear LiL: I read your recent post regarding gender wage disparity in the practice of law. As a physician – I hear you! This issue is not exclusive to the legal profession but something I’ve experienced throughout my career as well. Attached is an article published in the CMAJ in August 2020 entitled “Closing the gender pay gap in Canadian medicine”. As lawyers I appreciate your experiences are limited to your field, but do you have any insight to provide regarding this disparity within the world of medicine? Signed ~ Practicing Patience

Dear Practicing Patience:

Thank you so much for reaching out. For those of you that are just jumping in, we recently blogged about our interpretation of the in-house counsel compensation survey conducted by The Counsel Network (read that post here).

We read with interest the article that you sent along, and can’t say we are surprised to hear that women in the practice of medicine are subject to similar gender pay gaps and systemic biases to those experienced by women in law. Such bias exists across professions and is simply wrong.

The article provides a cogent, well-researched explanation for why the wage gap persists in medicine. Of course, studying this issue in the practice of medicine is somewhat easier given there is more transparency with respect to compensation than there is in the practice of law. In Canada this is driven by the fact that most physicians’ remuneration is fee-for-service. This allowed the article’s authors the ability to draw on a broad research-based set of data in reaching their conclusions. The authors had available to them research studies from a number of other jurisdictions and identified that the effect of the gender pay gap was apparent across a broad spectrum of the medical profession including clinical, research and academic environments.

The article illustrates how the gap has nothing to do with female physicians working fewer hours, seeing fewer patients or working less efficiently. Rather, the disparity in pay is driven by the type of work women do compared to men and a number of systemic barriers that female doctors face. For example, studies cited in this article confirmed that between 2014 and 2016, in Ontario, female surgeons earned 24 percent less per hour spent operating than their male counterparts. Researchers further found that, across the 200 most common surgical procedures, there was no appreciable time difference spent performing the procedures.

So, why this significant difference in pay? It turns out, female surgeons generally tend to perform less lucrative surgical procedures. It is the medical equivalent of getting a file where you receive a fraction of your hourly rate, while your male colleague gets to do the same or similar work on a full rate file.

Why does this happen? A number of very good reasons are offered by the authors, which include female doctors facing discrimination throughout their careers, rooted (as in law) in the history of women’s exclusion from the profession, institutional legacies of sexism that permeates medical schools, health care organization and the fee system itself.

Not convinced yet? There are disproportionately more male doctors in clinical leadership positions. Male specialists receive significantly more referrals from GPs than female specialists and women doctors perform disproportionately more procedures on female patients, which, shockingly, pay a lesser fee. The best example of this provided by the authors? A biopsy of a penis (performed more often by male doctors) pays more than a biopsy of a vulva (performed more often by female doctors).

Let’s go over their findings again:

– women in Canadian medicine consistently earn less than men;
– the pay gap between women and men exists within every medical specialty and between specialties; and
– the gender pay gap in medicine is not explained by women working fewer hours or less efficiently but seems to be based on systemic bias starting in medical school.

Similar to the conclusions that we drew in our recent blog related to the practice of law, these two authors offer actions for closing the gender pay gap in medicine including:

– anti-oppression training;
– challenging the hidden curriculum and medical education;
– fair and transparent hiring and referral processes; and
– changing the relative value of fee codes and transparent reporting of physician payments stratified by gender.

They also raise the very important need to engage men in supporting the careers of women. Not just as mentors but actively advocating for equality, as sponsors and champions of female physicians.

Final Thoughts

Clearly, even in 2020, we have much to do to address the gender pay gap. Not only in the legal profession but across professions, as this article demonstrates. Only through supporting and advocating for equal pay across all areas of employment can we address discrimination in all forms.

Read the complete August 2020 CMAJ “Closing the gender pay gap in Canadian medicine article here (CMAJ 2020 August 31;192:E1011-7. doi: 10.1503/cmaj.200375)