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all specialty boards and accrediting bodies should require hospitals to offer appropriate parental leave for all physicians. While this is already in place in many of the more gender-balanced specialties, the male-dominated specialties tend to be the furthest behind. Many departments don’t have parental leave policies at all. This is self-defeating, if leaders in these specialties truly want to encourage women to enter their field.
Second, the medical profession needs to reconsider how value is attributed to the work of physicians. The current reimbursement system heavily favors procedural specialties, which tend to be dominated by men. While some may argue that women “choose” to enter less well-paying specialties, this fails to consider the outright discrimination against women, as described by Dr. Hussein, particularly prevalent in surgical specialties. It also does not recognize that for complex cultural reasons, women may prefer non-procedural specialties, which historically have been considered more “feminine.” Just as traditionally male industrial jobs tend to pay better wages than traditionally female jobs in clerical professions, the “male” medical specialties receive better compensation than the more “female” specialties.
Whatever the reason that fewer women enter procedural specialties, women in medicine should not feel obligated to enter those specialties in order to receive the best pay. The current reimbursement system should be restructured to reimburse non-procedural work more equitably with procedural work. After all, successfully counseling a patient to quit smoking is just as valuable to society as cutting out a tumor from a lung, even though the difference in reimbursement for the two activities is drastically different.
Last, an article published in JAMA Surgery this month by Dr. Fahima Dossa and her colleagues showed that, in Ontario, women surgeons in the same subspecialty earn less money than men surgeons, even after adjusting for the amount of time they spend in the operating room and how efficiently they work. Women tend to spend their time doing less lucrative types of surgery, performing only 6 percent of the best-reimbursed common surgeries, compared with 27 percent of the worst-paid surgeries (25 percent of the surgeons in the study were women). Why? It’s probably not that women don’t care about how much they’re paid. The best explanation for this difference is that women surgeons receive fewer referrals for the most lucrative surgeries than do men.
Of all the sources of pay discrepancy between men and women, this may be the most difficult to address because it would be hard to mandate gender balance in referrals from the top down. One plausible approach would be to have all elective surgical referrals distributed evenly among physicians who are qualified to perform the surgery. This approach, however, will frustrate doctors who have a good working relationship with a specific surgeon and prefer to refer cases to that person. This change will need to be instituted gradually and thoughtfully.
We know what to do to start addressing this problem of pay imbalance in medicine. The reimbursement system should be rebalanced toward non-procedural specialties, all medical specialties should offer fair parental leave, and referring physicians must not preferentially refer to male doctors for the more remunerative procedures. It won’t be a simple fix, but these three changes would be a good start.