Closing the Gap: Gender Equity in Anesthesiology Pay
Norah Janosy MD, Rebecca Margolis DO, Myron Yaster MD, Kim Strupp MD
You don’t have to look very far to read an article on the persistent gap in pay and total financial compensation between men and women. A quick Google search will reveal that this topic is commonly studied, written about, and reported on. The Pew Research Center, a nonpartisan American think tank based in Washington, D.C., reports that over the past 20 years, the national gender pay gap has remained persistently stagnant with women earning approximately 80 cents for every dollar earned by men.1 The reason for this persistent wage gap has been attributed to some measurable factors but also includes some difficult-to-calculate and quantifiable factors. For a deeper dive, I’d urge you to download and read the full Pew report.
So you might ask—what about fields that require highly skilled professionals like physicians and more specifically pediatric anesthesiologists? Well, we really don’t know if this gap exists because we simply don’t have the data! We do have some data based on a survey of all members of the American Society of Anesthesiologists (ASA) published in 2021 by Hertzberg et al.2 To get more granular pediatric anesthesia data, an ad hoc group of members of the Society for Pediatric Anesthesia (Kim Strupp MD (Children’s Hospital Colorado), Rebecca Margolis DO (Children’s Hospital Los Angeles), Lindsay Love Baptist MD (Children’s Hospital Philadelphia), Tom Austin MD (University of Arkansas for Medical Sciences), Laura Berenstain MD (Retired), Myron Yaster MD (Retired), Linda Hertzberg MD (Retired) and Norah Janosy MD (Children’s Hospital Colorado)) developed a compensation survey that was finally approved and distributed to its members last week. After I received my survey, I asked Drs. Janosy, Margolis, and Strupp to review the original Hertzberg paper for today’s PAAD to jump start your thinking about this topic and provide the activation energy to get you to respond to the survey.
One important disclaimer: The PAAD no longer has any affiliation with SPA and I’ve been asked to not include a link to the survey in today’s PAAD. Rather, this is a personal request from me to all of our readers who are SPA members. The great problem with all survey studies is the response rate, and response rates to all surveys are declining...let’s call it survey fatigue. As an author of this new compensation survey (and hopefully future publications), I am asking, really begging all of you readers of the PAAD who are members of SPA to complete the survey ASAP! We need the data from as many of you as possible! Myron Yaster MD
Original article
Hertzberg LB, Miller TR, Byerly S, Rebello E, Flood P, Malinzak EB, Doyle CA, Pease S, Rock-Klotz JA, Kraus MB, Pai SL. Gender Differences in Compensation in Anesthesiology in the United States: Results of a National Survey of Anesthesiologists. Anesth Analg. 2021 Oct 1;133(4):1009-1018. doi: 10.1213/ANE.0000000000005676. PMID: 34375316.
When I (MY) went to medical school in the 1970s less than 10% of my classmates were women. Today women comprise a little over 50% of all medical school classes, which by any yardstick is an incredible achievement. However, the compensation of women physicians over their careers lags far behind men physicians. Indeed, the physician gender-related wage gap has been estimated to be about 25% and results in a staggering 2-million-dollar difference in compensation over the course of their careers.3 This gap occurs evens when accounting for factors like specialty, hours worked, location, and years of experience.4
In today’s PAAD, Hertzberg et. al.2 in 2018 sent an electronic survey to 29, 000 U.S. members of the ASA to discover if gender gaps existed in how men and women were financially compensated. The survey was designed with gender as the primary variable, and compensation by gender, the primary outcome. The survey used the definition of compensation to include salary, bonuses, incentive pay, research stipends, honoraria and distribution of profits to employees.
OK, what did they find? After adjusting for potential confounding variables, women anesthesiologists have lower compensation than their male counterparts. Or, in the words of Captain Renault in the immortal movie Casablanca, as he was given his gambling winnings and was forced by the Germans to close down Rick’s café: “I’m shocked, just shocked to find that gambling is going on here!”
The survey used the definition of compensation to include: salary, bonuses, incentive pay, research stipends, honoraria and distribution of profits to employees. The results of this survey analysis are consistent with other previously published data: After adjusting for potential confounding variables, women anesthesiologists have lower compensation than their male counterparts. In fact, after adjusting for age, hours worked, geographic practice region, practice type, position, and job selection criteria, the authors found that women anesthesiologists women consistently find themselves on the short end of the compensation stick. The gap? A staggering $32,617 per year less than their male counterparts. This wage gap spanned across both private practice and academic settings. Women who were partners in private practice settings had lower compensation packages than men. Of the academic women who responded, a considerable percentage held the rank of assistant professor which is significant because in many academic practices’ compensation is tied to academic rank. Multiple studies have shown that women medical school faculty do not advance as rapidly and are not paid at the same level as professionally equivalent men.5,6
But here's the kicker: the response rate in the Hertzberg study was a measly 7.2%. We need your help and today’s PAAD is our plea to rally the troops (YOU!): Please pay attention to your email and when you see the SPA gender compensation survey please complete and return it. Send your thoughts and comments to Myron who will post in a Friday reader response
PS from Myron:
A depressing word of caution. And this will upset many of you so don’t shoot the messenger. “The gender composition of physician specialties varies dramatically with some becoming increasingly female predominant while others remain overwhelmingly male. In their analysis of physician workforce data, Pelley et al.7 demonstrate that despite large increases in the number of female physicians over 4 decades, the degree of gender segregation between specialties has not declined. The authors describe lessons from the highly gender-segregated U.S. workforce as a whole to understand these demographic patterns in the physician workforce. Echoing U.S. workforce findings, women physicians are becoming overrepresented in certain specialties, and this appears to be associated with a relative decline in earnings for all physicians in these specialties over time. The authors found a strong negative relationship between the proportion of female physicians in a specialty and its mean salary, with gender composition explaining 64% of the variation in salaries among the medical specialties. Female physicians face biases in the workplace and fall behind male peers in leadership attainment, academic advancement, and earnings. Tenacious gender stereotypes and the conflation of gender and status contribute to these biases and reinforce occupational gender segregation. The clustering of women in certain specialties means these specialties will be disproportionately affected by gender bias. Recognizing the consequences of gender demographics within physician specialties is important to maintain the strong and diverse physician workforce needed to support the health care needs of the populations who depend on these specialties for care.”7
References:
1. Aragao C. Pew research center: Gender pay gap in U.S. hasn’t changed much in two decades. (https://www.pewresearch.org/short-reads/2023/03/01/gender-pay-gap-facts/).
2. Hertzberg LB, Miller TR, Byerly S, et al. Gender Differences in Compensation in Anesthesiology in the United States: Results of a National Survey of Anesthesiologists. Anesthesia and analgesia 2021;133(4):1009-1018. (In eng). DOI: 10.1213/ane.0000000000005676.
3. Whaley CM, Koo T, Arora VM, Ganguli I, Gross N, Jena AB. Female Physicians Earn An Estimated $2 Million Less Than Male Physicians Over A Simulated 40-Year Career. Health affairs (Project Hope) 2021;40(12):1856-1864. (In eng). DOI: 10.1377/hlthaff.2021.00461.
4. Tricco AC, Nincic V, Darvesh N, et al. Global evidence of gender equity in academic health research: a scoping review. BMJ Open 2023;13(2):e067771. (In eng). DOI: 10.1136/bmjopen-2022-067771.
5. Ash AS, Carr PL, Goldstein R, Friedman RH. Compensation and advancement of women in academic medicine: is there equity? Annals of internal medicine 2004;141(3):205-12. (In eng). DOI: 10.7326/0003-4819-141-3-200408030-00009.
6. Richter KP, Clark L, Wick JA, et al. Women Physicians and Promotion in Academic Medicine. The New England journal of medicine 2020;383(22):2148-2157. (In eng). DOI: 10.1056/NEJMsa1916935.
7. Pelley E, Carnes M. When a Specialty Becomes "Women's Work": Trends in and Implications of Specialty Gender Segregation in Medicine. Acad Med 2020;95(10):1499-1506. (In eng). DOI: 10.1097/acm.0000000000003555.