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So recently, one of my co-bloggers asked me if we'd ever done a Healthcare Triage on the gender pay gap in medicine. I realized we hadn't. We're going to fix that right now.

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John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen -- Graphics
So recently, one of my co-bloggers Tweeted at me, asking me if we've ever done a Healthcare Triage on the gender pay gap in medicine. I realized we hadn't. We're gonna fix that right now. Gender pay discrepancies are the topic of this week's Healthcare Triage.

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I work in a medical specialty that's dominated by women. Almost all the physicians in my section are women. Almost all of my fellows have been women. Pretty much every one of my mentees has been a woman. So I talk about women's salaries in medicine quite a bit. And the subject of whether women are paid differently comes up often.

Now this is when a lot of you will starting telling me that it's anecdotal, or it's cause women wanna work part-time, or blah, blah, blah. As I told my daughter recently when she asked, I had to pretty much go through the 25th grade to get this job. You know what? So did the women in my field.

And let's forget anecdotes. To the research!

In Health Affairs in 2011, a study was published entitled, "The $16,819 pay gap for newly trained physicians: the unexplained trend of men earning more than women." Let's dig in.

The authors abstracted data from the New York State Survey of Residents Completing Training, which is run each year by the Center for Health Workforce Studies of the State University of New York at Albany. Other than one or two years when funds prevented the survey from being completed, it's been fielded every year since 1998.

They took data from 1999 to 2008. The authors were most interested in the residents' starting salary, defined as the self-reported base salary plus expected incentive compensation.

And it's good to look at the starting salaries, because that's when everyone is equal, having just completed training. It's not a time when people would have big differences for a variety of other reasons.

First, let's look at the unadjusted analyses. Here are starting salaries for men and women in selected physician specialties. Not only do women have a lower starting salary overall, they have a lower starting salary in nearly every single specialty. 

I took a look in the appendix, and if you look at all 45 specialty groups, women lose in every one but 4: general surgery, critical care, gastroenterology, and other anesthesiology subspecialty. These 4 specialties account for only 2.9% of graduating female residents.

That's sort of stunning. But it's possible that other factors come into play. Maybe all the women chose jobs with fewer hours, or in cheap places to live. So the authors conducted analyses that looked at average mean salary while controlling for those things.

These included the 45 categories of specialty training, race/ethnicity, age, citizenship, foreign medical graduate status, whether graduates had an MD or an OD degree, educational debt, health professional shortage work area obligations, practice type, location type, patient care hours, and the year.

Did that get rid of the discrepancy? No.

The solid lines in the chart you're looking at are the unadjusted analyses. So the controlled analyses, or dotted lines, about halves the discrepancy. But this means that after controlling for all these other factors, men still had a significantly higher starting salary than did women.

Not only that, but it's getting worse. It's risen from 3,600 in 1999 to over 16,000 in 2008. That's not the only research we can look at. There's a more recent study in JAMA Internal Medicine, "Gender differences in the salaries of physician researchers."

The authors of this study surveyed all doctors who had received career development grants from the NIH in 2000 to 2003. That's a pretty smart idea, because you can assume that people getting K Awards aren't really working part-time, cuz they wouldn't be eligible. They really need to be tenure-track faculty. They got a fantastic response rate to their survey, and they wanted to see if men were making more than women in research. They, of course, are.

Men made on average $200,433. Versus women, who made $167,669. Now, there are some valid reasons that this could be. So the researchers designed the study to account for these differences. I mean, come on. Let's get the usual caveats out of the way. This was a complicated analysis that compensated for the usual factors (or excuses) people try to bring up when confronted with the fact that women make less than men.

They accounted for demographic factors. They accounted for whether people were married or had kids. They accounted for other degrees, specialty and leadership positions. They accounted for how many hours people worked and the time they spent in research.

And I think you could make an argument they were too conservative. After all, there are more men in leadership positions than women, even in women-dominated specialties. More men get promoted than women. And unless this is totally deserved, it's skewing the findings towards making a case that men should make more than women.

But even if you ignore this, do you know what they found? After controlling for all of the other factors, women were making a lot less than men were. They used a Peters-Belson analysis, which allowed them to find that if you described a physician-researcher and then kept every other factor constant but flipped the gender from male to female, that woman would make more than $12,000 less.

The authors of these studies offer a number of explanations for why this might be. Some put the fault in the system, and some try to come up with other factors that could legitimately explain the difference.

I'd say that the onus is on the system, however. There's a discrepancy. It's getting larger, and it's not easily explained by any of the usual excuses.

I've covered this issue a number of times in my blog. One time I did, a commenter used the results, of the fact that women make less than men, as proof that women are inferior physicians. We have a long way to go here. Even in academic medicine.

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