Racial Disparities in Compensation
Myron Yaster MD, Norah Janosy MD, Mofya Diallo MD MPH and Rebecca Margolis DO
“I can’t prove it but I know it’s true” Bill Maher
Today’s PAAD by Vandenberg et al.1 is a relook at data from an article by Hertzberg et al.2 that looked at gender differences in compensation amongst anesthesiologists. In that study, Hertzberg et al. reported a $32,617 reduction in annual compensation for female anesthesiologists when compared to male anesthesiologists, after adjusting for potential confounding factors.2 Using that same data set, Vandenberg et al. looked at racial compensation disparities.
Drs. Norah Janosy and Rebecca Margolis are the PAAD’s well-being editors, and we debated at length amongst ourselves about reviewing today’s article because it is based on data from a survey of members of the American Society of Anesthesiologists in which the response rate was very low (6.8%). With such a low response rate Is the data valid? But channeling Bill Maher I decided to put my thumb on the scale: “even though I really can’t prove it…I just know it’s true.” Myron Yaster MD
Original article
Vandenberg MT, Kraus M, Misra L, Hertzberg L, Buckner-Petty S, Padmanabhan A, Tollinche LE, Milam AJ. Racial Disparities in Compensation Among US Anesthesiologists: Results of a National Survey of Anesthesiologists. Anesth Analg. 2023 Aug 1;137(2):268-276. PMID: 37097908.
“Despite overwhelming evidence that individuals from racial and ethnic minority populations earn less than their non-Hispanic White counterparts in most sectors of the US labor market, national estimates of differences in annual income between physicians by race and ethnicity in the United States are limited.”1 However, “a 2016 study utilizing 2 large data sets and including most physician specialties reported that White male physicians had a higher median annual income than Black male physicians after controlling for potential confounders (difference of $64,812, P < .001). Furthermore, while White and Black female physicians earned similar incomes to each other, their income was significantly less than their male counterparts.”3 In today’s PAAD, Vandenberg et al. “examined national survey data utilized in Hertzberg et als’ study2 “ to determine whether there were racial and ethnic differences in compensation among anesthesiologists in the United States.”1
28,812 active members of the American Society of Anesthesiologists were surveyed. The final analytical sample consisted of 1952 anesthesiologists (78% non-Hispanic White) or about a 6.8% response rate. “The analytic sample represented a higher percentage of White, female, and younger physicians compared to the demographic makeup of anesthesiologists in the United States. When comparing non-Hispanic White anesthesiologists with anesthesiologists from other racial and ethnic minority groups, (ie, American Indian/Alaska Native, Asian, Black, Hispanic, and Native Hawaiian/Pacific Islander), the dependent variable (compensation range) and 6 of the covariates (sex, age, spousal work status, region, practice type, and completed fellowship) had significant differences. In the adjusted model, anesthesiologists from racial and ethnic minority populations had 26% lower odds of being in a higher compensation range compared to White anesthesiologists (OR, 0.74; 95% confidence interval [CI], 0.61–0.91).”1
The authors concluded that compensation for anesthesiologists reveals a significant disparity associated with race and ethnicity even after adjusting for differences in age, sex, hours worked, geographic practice region, and academic rank. These results raise concerns that processes, policies, or biases (either implicit or explicit) persist and may be associated with significant compensation differences for racial and ethnic minority populations.”1
As we have discussed in several previous PAADs, the physician workforce in anesthesiology is neither reflective of the general patient population in the United States nor of the general demographic of practicing physicians throughout all medical fields. We can only ask even considering this “why isn’t there pay parity?” Or perhaps better said “why isn’t there equal pay for equal work and now how can we change this?” To enhance belonging, and ultimately workforce retention among anesthesiologists, our specialty will need to tackle these issues.
We have no idea if these results are also true for our subspecialty of pediatric anesthesiology. However, equity does not just occur, it must be planned for and measured in all aspects, even among us. We and a group consisting of leaders in the field have been trying for the past 2 years to distribute a similar survey to members of the Society for Pediatric Anesthesia without success. This information is vital to our specialty, and we are hoping that the SPA executive council will finally approve it (hint hint).
Finally, Vandenberg et al. offer some targeted solutions for both private and academic practices. Because I (MY) am trying to limit the length of PAADs to 5-6 minute reads, we will revisit this issue in the next couple of weeks.
What do you think? Please send your thoughts to Myron who will post in a Friday Reader Response.
References
1. Vandenberg MT, Kraus M, Misra L, et al. Racial Disparities in Compensation Among US Anesthesiologists: Results of a National Survey of Anesthesiologists. Anesthesia and analgesia. Aug 1 2023;137(2):268-276. doi:10.1213/ane.0000000000006484
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. Oct 1 2021;133(4):1009-1018. doi:10.1213/ane.0000000000005676
3. Ly DP, Seabury SA, Jena AB. Differences in incomes of physicians in the United States by race and sex: observational study. BMJ (Clinical research ed). Jun 7 2016;353:i2923. doi:10.1136/bmj.i2923