Gender pay gap and fairness

A much discussed topic recently is the gender pay gap in physician salaries. A report from Medscape, an online resource for medical professionals, states that white or male physicians earn significantly more than women or minority physicians. Doximity, an online physician community, also found similar results in an annual survey of physician pay. The Medscape survey is crude citing age, choice of specialty and bias as confounding factors and reminiscent of the experiment in Great Britain mandating companies to publicize the gender pay gap irrespective of rank or responsibility. Considering that the average pay in neurosurgery is approximately 3 times the average pay in family medicine, and there are far more male neurosurgeons than female counterparts it seems unfair to cite numbers without adjusting for variables. Doximity does break up the numbers by geography and different specialty. Charleston, SC has the largest reported pay gap with female physicians earning 37% less while hematology has the largest pay gap among specialties paying female physicians 20 less.

As an internist practicing primary care I can understand how the pay gap is smaller in this field than in other specialties. The responsibilities and work flow is relatively standard while other specialties would need to work out the percentage of clinic time vs inpatient time (caring for patients admitted to the hospital) vs OR time (doing surgery in the operating room). For specialties that are on call for emergency room (neurology, gastroenterology, cardiology, all surgical specialties) the on call load (how many days  month you should be prepare to run to the hospital even at night for urgent patients presenting to the ER) may also be very different resulting in larger difference in work load even among full time physicians.
The full report from Doximity does not include a lot of detail. It is not even clear if only employed and  therefore salaried physician were included. People who do not believe in the pay gap often note that payers (insurance companies) cannot discriminate payment based on gender. With private practice being a business with the same payment scheme from payers it is hard to say there is an unfair pay gap unless you believe that there is a society wide discrimination against women trying to start a business.

There can be many biases against women in medicine for sure. Patients may be less likely to trust female physicians or be more unforgiving of mistakes. There is some evidence of this in the surgical field where the pay gap is larger. Women in medicine may have more difficulty building networks the same as women in technology therefore making it harder to build a successful private practice where often the income is higher than in employed positions.When discussing the pay gap there are a few things to clarify. What do we consider the main driver of the pay gap. If it is due to choosing different specialties are we trying promote having larger numbers of female neurosurgeons? How to deal with the delicate matter of patient trust if patients are less likely to trust female physicians who operate on them. Are large organizations that employ thousands of physicians actually paying different rates to their female and male employees? One matter that makes this topic harder to discuss is the obscurity of actual physician pay. Often physicians do not know the actual income of fellow physicians. In that aspect the initiative by Doximity is providing some new light with the nations wide survey with open salary information in easy to navigate maps although information is only disclosed to healthcare professionals.

The Life Changing Magic of Tidying Up

I have had quite an impression from the book The Life Changing Magic of Tidying Up by Marie Kondo. Although it is a little odd that the positive examples given at the end of the book all relate to clients that quit their jobs to start a new business, I do relate to the statement that having to much "stuff" in your house can distract you from your true interest and passion.
I aim to promote a simple lifestyle not only in your possessions but also in your day to day work flow and in managing responsibilities at home and at work in this blog. I seek to relate insight in the different healthcare systems in the world with my perspective as a medical graduate from South Korea and a practicing primary care physician in the United States. I would like to discuss my views on the health care system of the United States with an economic perspective to health care costs, efficiency and access to care.