Women in medicine: a level financial playing field?

Today, we watched the 75th Golden Globes unfold in a sea of black dresses, pins saying 'Times Up' and Oprah Winfrey giving an impassioned speech on how little girls will very soon, not live in fear. The impetus for this? The ongoing and relentless naming and shaming of some of Hollywood's biggest names who have abused their position and harassed, assaulted and demeaned both men and women in a flagrant abuse of power. 

The rising up of women everywhere has been coming for some time now. Inch by inch, in virtually every industry there is, women are moving on from 'whisper groups', where sub-terranean groups of women whisper to one another about who to avoid being in a room with. Now, women are quite frankly, jack of the inequality, the lack of diversity, the sexual harassment and the blatant unfairness of it all. 

Once relegated to a small section of news websites, stories on inequality that disadvantage women are now taking centre stage. A quick glance at the Harvard Business Review front page today, greeted me with scores of articles on gender in the workplace. In that vein, I shared this article from the New Yorker, about how women in the finance industry were fighting back against gross pay inequality. 

In sharing this article, of course there is discourse on social media. Likes, shares or replies of frustration, commiseration or identification tend to come with something like this. It was this reply that got me though:

"Happily, some of us don't work on Wall Street, and have gender pay parity as well as equity in recourse for any bullying, harassment or discrimination."

Back and forth, the tweets by this male doctor were basically directed at saying, 'thankfully, with rules and regulations, we don't have that problem in our industry'. Also known as the "I've never seen that therefore it can't be true" defence. I'm never one to engage on social media. Especially when someone invokes this line of reasoning. However, it is that exact attitude that leads to stagnation of a system that every piece of evidence every suggests is true. 

When it comes to gender discrimination, we have entered an era where the majority of discrimination at least, is covert. HBR refers to this as unseen barriers, a scourge of second generation sexism in their excellent article. One of the distinct advantages of looking at the financial differences between men and women is that cash is cold and hard. You can follow it and see where it goes. Just like finance, entertainment and a whole host of other industries, women doctors make less money than men. 

Despite rules and regulations or that we are covered by the exact same contracts, awards or regulations, equal work in health care definitely does not mean equal pay. Robust data from the US and UK have demonstrated that women doctors are paid somewhere around 29% less than their male counterparts. In the US, this amounts to USD $20,000 annually. But it's okay. There are rules against that so relax.

So why? Why even under the auspices or legislation or rules or processes are women doctors still missing out on the moolah? I really wanted to know, so I did the least scientific things I could. I Googled it and I asked some friends. (To be fair, I did make sure that I got the best results of Google and have referenced them here. And my friends are smart as hell.)

  1. It's not about kids
    • Women who earn less often have this pay gap explained away by taking time of for childbearing. Research has shown that this is not the case, for when women who don't have children compare their salaries to men, the pay gap persists
       
  2. It might be about caring
    • In the book The Changing Face of Women in Medicine, there is much talk about the kinds of clinical behaviours that are expected and performed by women doctors. Unsurprisingly, women doctors do more 'caring' type activities which unsurprisingly, do not pay well. You can't bill for time spent counselling someone or organising to get support services. Women physicians are more likely to look after poorer patients, which again puts a dent in their income. 
       
  3. We're not in the club
    • Women are less likely to be elected to the multitude of boards or other higher positions including those in academia. These positions carry a significant amount of prestige that are undeniably useful in job applications, referral patterns, This is just a part of there pervasive and often unconscious biases such as those that rate female-authored papers lower than male-authored papers. 
       
  4. We're babies still
    • The dominance of women in medical schools is relatively recent and so, women doctors tend to make up less senior ranks, leading to lower pay rates. Of course, this should even out with time but even after adjustments for experience, the gender pay gap persists. That being said, the fact that women make up more than half of medical graduates presently is often used to explain away bias and inequality. "60% of medical school graduates at X University are female now" is not an excuse or a comfort. Until that proportion follows on and women account for 60% of surgeons, of deans, of first-authors on scientific papers or on boards, then that number is a target not a reassurance. 
       
  5. We're fighting for our rights and pay isn't one of them
    • This is evidence that is anecdotal but illustrates an important point. At a women in medicine evening a few years back, I mentioned the gender pay gap in medicine. A male doctor in the audience asked me why and I gave him a list of variables including those above. When I brought up that women may be less likely to claim over time, his enlightened response was "Oh, so it's the women's fault then.". Yes mate, you have been absolved of your responsibility in this caper. 

      Claiming overtime is seen as frivolous and not in the spirit of what it is to be a doctor. It is very often frowned upon and so a large number of junior doctors do not claim overtime for extra hours worked due to fear of it looking unfavourably on them. Since women doctors are fighting against a whole host of other issues, this is one battle many choose to let go.

      In the same vein, women in medicine, where it is possible, are not good at negotiating pay rises. Stay woke team, it's not the women's fault as the bloke above thinks. There are penalties based on unconscious bias for women who ask for more. 
       
  6. We're punished more than men.
    • Research has shown that for women surgeons who have a complication or a sub-optimal outcome, they are punished by their referees with less referrals. (The original paper is here) Less referrals equals less money. 
       

Of course this is just a small bite of the apple. And despite the fact that there is evidence that suggest despite rules and regulations that we are all paid equally, the fact is that we are not. Even with the same award and the same contract, errors are made. I mean if we compare it to the Weinstein saga, there were rules and standards about how your touch someone or maintain a safe workplace. Yet, they still got ignored. A lack of rules is not our problem. A lack of open mindedness to the existence of an issue is our problem.

I think that one of the most dangerous mindsets is that because you've never seen it happen, it means it does not exist. (Or it affects a minuscule portion of people). Falling back on your own limited experience or falling back on the rules means that at times, we miss the very serious issues that encompass someone else's experience. Or that break all of the rules. 

Part of the exposure of women in Hollywood is about no longer sweeping inequality under the carpet. It's about calling out that Time's Up for inequality, discrimination and harassment. This is an ideal that should be spread far and wide. So cast away your closed mindedness and remember that our problems will not go away with inaction. They will vanish once we acknowledge them, learn about them and take steps to deal with them.