Before getting to today’s PAAD, earlier this week I forgot to wish you all Kung Hee Fat Choy! Happy Chinese/Lunar New Years (year of the tiger)!
As I explained in yesterday’s PAAD, I asked my good friend and colleague, Lynne Ferrari MD, the Associate Chief Medical Officer and Vice Chair Department of Anesthesiology, Boston Children’s Hospital, and the Robert M. Smith Chair in Pediatric Anesthesiology to review this editorial for the PAAD which has a different spin on the conclusions of yesterday’s PAAD on the same topic. This editorial underscores one of my pet peeves, namely, women are often asked to take on departmental operational “good citizenship” roles, like scheduling, “running the board”, working on intra-departmental committees, running the residency/fellowship programs, etc. These roles are vital for the functioning of a department and yet are rarely, if ever considered in academic promotion and advancement. Further, because in academic departments pay is often linked to academic title, it doesn’t take a genius to see the negative consequences of being a good citizen.
Finally, Ron Litman’s wife Daphne, who avidly reads the PAAD sent me this classic Mary Tyler Moore video first aired in 1972(!) to share with all of you. Enjoy! Myron Yaster MD
Editorial:
Amy C S Pearson, Lisa R Leffert, Zeev N Kain. The "Unexplained" Portion of the Gender Pay Gap in Anesthesiology. Anesth Analg. 2022 Jan 1;134(1):44-48 PMID: 34908545
The article by Hertzberg et al. in October 2021 demonstrated a significant pay gap among anesthesiologists associated with gender despite adjusting for confounding factors.(1) The editorial by Pearson and colleagues challenges the reader to explore the “unexplained” elements that contribute to gender bias in compensation among anesthesiologists.
Recent research estimates that US women earn 84% of what men earn and for physicians, the current pay gap is estimated to be approximately 29% or $19 billion with a subsequent increase of 2.8% during the current pandemic. Between 2019 and 2020 the American Association of Medical Colleges confirmed a pay gap at every level in academic anesthesiology except department chair. Furthermore, the subspecialties of pediatric anesthesia and pain management exhibit the most significant gender based compensation differential. What is not discussed in the original article was an assessment of the influence of institutional culture and leadership on the pay gap. It is possible that women fail to feel empowered to negotiate both salary as well as responsibilities, often agreeing to take on non-income generating operational positions with the goal of being a “good citizen and team player”.
If compensation is in part determined by academic rank, might this contribute to what is “unexplained”? The attrition of midcareer women in medicine is well documented and often attributed to lack of personal advancement, childcare needs, leadership conflict, harassment and low salary. Female faculty who are involved in efforts that enhance patient care, organizational effectiveness and institutional reputation are often taken for granted and not considered to have significant impact. The “Gender Pay Gap” may in fact be fueled by the “Promotion Gap” which identifies gender disparity with respect to promotion even after accounting for age, experience, specialty and research productivity among women in academic medicine.(2) In an era in which women have closed the gender gap with regard to medical school admission, women remain underrepresented in upper faculty ranks. In a sample of 559,098 graduates from 134 U.S. medical schools, fewer women than expected were promoted to associate or full professor or appointed to the position of department chair. Academic medicine appears to have fallen behind the disciplines of science, technology, engineering and mathematics (STEM) in eliminating gender differences in promotion. A national study reported that although female and male faculty had similar leadership aspirations, women perceived that institutional culture did not support efforts to address diversity goals. Potential causes which have been suggested include the persistence of the “old boys’ club” mentality, lack of gender parity in leadership and failure of women to oversee high-stakes, highly influential clinical or research missions.(3) Freedom from gender bias, support for work-life balance, equal access to opportunities and a supportive department chair are known to endorse a culture that is conducive to academic success for female faculty. Women who have advanced professionally often have had mentors and allies in leadership positions who have steered key assignments to them, included them in high-level meetings and kept them visibly in the mix for promotion. What is often forgotten is that the most important decisions about your career usually happen in a room when you are not present.(4) An intentional readjustment of yesterday’s rules to today’s realities and a strategic focus to pivot will get us to a place when the best man for the job will often be a woman.(5)
Lynne R. Ferrari, MD, Associate Chief Medical Officer Perioperative Strategy & Risk Vice Chair Strategy and Planning, Dept. of Anesthesiology Robert M. Smith Chair in Pediatric Anesthesiology Boston Children’s Hospital
References:
1. 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.
2. Richter KP, Clark L, Wick JA, et al. "Women physicians and promotion in academic medicine." New England Journal of Medicine 383.22 (2020): 2148-2157
3. Roberts LW. “Women and Academic Medicine”, Academic Medicine Vol 95 (10): October 2020: 1459-1464
4. Ammerman C, Groysberg B. "How to Close the Gender Gap." Harvard Business Review, Vol 99 (3) May–June 2021: 124–133
5. Wittenberg-Cox, A. “If You Can’t Find a Spouse Who Supports Your Career, Stay Single”. Harvard Business Review, Vol.95 (5) September-October 2017