Bridging the gender pay gap in medicine and healthcare

When we talk about compensation equity, we have to encourage people to consider this issue as part of a broader context of supporting and cultivating cultures that allow women to advance within academic medicine, science and healthcare. The gender pay gap is a convergence of all the forces that come together in these professions to diminish the value and the contribution of women.

The gender pay gap is significant. In the US, women physicians earn 75 cents on the dollar compared with their equally talented male counterparts. In fact, women physicians have one of the worst gender pay gaps in the whole US labour market. Women earn less than men in every specialty and in every academic rank. Unfortunately, these disparities begin right out of medical training. The data in the UK and the EU is similar.

Research has shown that pay transparency as an antidote to pay secrecy does lead to more equity in compensation. I wholeheartedly believe that transparency, having stated benchmarks and ranges around compensation, is a way to address the gender pay gap. There is robust evidence that women in the workplace suffer penalties when negotiating for resources and pay. Transparency mitigates that element of gender bias, because if there’s transparency about pay grades, that takes negotiation off the table.

There have been simulated experimental studies in which women and men actors were given the same scripts and the same parameters to enter into negotiation. The negotiators were then observed for both their written reactions as well as verbal and body language.

It was clear that a woman advocating for herself in the same way as another male actor was penalised; she was thought to be more aggressive, or not given the same salary, or not given the same resources. That’s the backlash, or social penalty, which is another term often used in the literature, that women experience in self-advocacy, and men do not. There’s also some literature around underrepresented minorities experiencing the same kind of negotiation penalty as women.

The solution is not about advocating better, because the women are not doing anything differently. It’s really about the perception and the cultural expectation and the cultural context in which what she’s doing is being received. Again, in these experimental studies, the male actors are doing the exact same thing, so it’s really about the perceptions. That brings us back to this idea of unconscious biases and expectations about how women should behave and what a woman leader looks like.

People on the hiring side really need to pay attention to their own implicit biases. We need to put transparent processes in place that will mitigate potential unconscious biases on the part of the hiring official, because no one’s perfect. We all have unconscious bias. We have to do as much as we can to eliminate it.

Organisations need to take a thorough inventory of their current compensation methodologies to uncover what expectations and outcomes they may be inadvertently generating. They need to rethink compensation methodology through an equity lens that accounts for the unique contributions of women and the potential biases affecting them. Assessments should be made of not just compensation, but also recruitment announcements, recruitment venues and hiring practices. And it’s critical to monitor the outcomes of all those inflection points and processes.

Let’s say an organisation undergoes a salary audit, looks at its compensation methodologies and what the methodologies are producing, and is offered an intervention to improve equity. It’s not done there. Organisations need to track and hold people accountable for moving that needle forward to make sure that any intervention or process change is reaching the desired outcome.

On a national level, there are a lot of enterprises in the US, the UK and the EU that fund medicine and science and that accredit institutions to train medical students. These enterprises have the ability – and this has happened in the UK – to make multiple aspects of gender equity, such as leadership representation and salary equity, part of an assessment of an institution; in other words, part of a potential fund recipient’s eligibility to receive grant money or accreditation.

Organisations should make sure that opportunities for leadership are publicised widely, whether it’s an internal leadership opportunity or one open to external talent. Traditionally, a lot of leadership opportunities were by word of mouth. The data show that women and individuals from underrepresented minorities don’t have the same power networks that white men have, so broadly advertising opportunities for advancement necessarily democratises the process.

In academic medicine and science, there are different resources that are needed depending on one’s career trajectory. For someone who does mostly research, an initial package could include startup funds and space for a lab. If someone is a clinical researcher, a package could include startup funds to hire support staff or a data analyst or a research assistant.

Those elements of support are critical for future success. There is data showing that men of equal qualification get larger startup packages, so it’s critical that there are some guardrails around what can be offered. Just as there are benchmarks for median salary, there should be benchmarks within an institution of what is permitted, and a process in place if there are outliers that need to be considered.

Not every situation or negotiation has to be uniform, because every situation has different elements to it. But there needs to be a process if something goes beyond the standard range for adjudication, so we don’t have opportunities for these subjective second-generation gender biases to creep in.