Perspective from Shikha Jain, MD, FACP
Disclosures: Redberg reports receiving grants from Arnold Ventures, the Greenwall Foundation and the National Heart, Lung, and Blood Institute outside the editorial. Reza reports no relevant financial disclosures. Please see the study and editorial for all other authors’ relevant financial disclosures.
July 12, 2021
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Gender pay gap persists in academic internal medicine

Perspective from Shikha Jain, MD, FACP
Disclosures: Redberg reports receiving grants from Arnold Ventures, the Greenwall Foundation and the National Heart, Lung, and Blood Institute outside the editorial. Reza reports no relevant financial disclosures. Please see the study and editorial for all other authors’ relevant financial disclosures.
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Despite the increasing number of women entering academic internal medicine, researchers found that “substantial salary inequities persist at the highest faculty levels and specifically in procedural-based specialties.”

Nosheen Reza, MD, a physician within the department of medicine at the University of Pennsylvania Perelman School of Medicine, and colleagues analyzed data from the 2018 to 2019 Association of American Medical Colleges Faculty Salary Report. Their study included 21,905 faculty members in internal medicine specialties at 154 U.S. medical schools.

The quote is: "Why are women consistently paid less than their male colleagues for performing equivalent work, and why is this disparity most pronounced in male-dominated specialties?" The source of the quote is Shikha Jain, MD, FACP.

Although similar studies have been done for more than 2 decades, “in recent years, the number of women pursuing careers in medicine has increased, and now, more women than men are enrolled in U.S. medical schools,” Reza told Healio Primary Care. “We wanted to take a contemporary look at the composition of the U.S. academic internal medicine physician workforce and evaluate the relationships between the representation of women in each internal medicine specialty with their salaries and academic rank.”

The researchers wrote that women comprised fewer than 50% of full-time faculty across all ranks. Although female representation was nearly the same at the instructor and assistant levels (47% vs. 46%, respectively), their percentage dropped to 24% in higher ranking positions. Women made up the majority of those in general internal medicine, endocrinology and geriatrics, but the specialties of pulmonology, critical/intensive care, gastroenterology and cardiology had the fewest female faculty. Cardiology showed “the greatest imbalance,” the researchers said, with only 21% being women. Although the median annual salary for women was lower across all faculty ranks compared with men, it was within an absolute difference of $25,000 at all ranks except for chief.

When the researchers analyzed the data by internal medicine specialty, they found that women were paid at least 90% of men’s median annual salary in all but cardiology, gastroenterology and critical/intensive care. Those three specialties tended to pay women more overall, but they also demonstrated “the largest gender disparities in both representation and salary, particularly within the higher ranks of cardiology and gastroenterology.” Moreover, men’s salaries still surpassed those of women in 90% of categories of faculty rank in academic internal medicine.

The analysis yielded a “number of surprising findings [that] underscore the urgent need to institute systematic changes to eliminate gender-based workforce disparities in academic internal medicine,” Reza said.

She encouraged a “deliberate and multidimensional approach to close the gender pay gap in internal medicine.” Specifically, institutions should make certain that all new hires are paid fairly and that salaries are “benchmarked and regularly reviewed by leadership to identify and rectify disparities.”

Nosheen Reza

Also, “institutional leaders and administrators should be transparent with their workforce about how salaries are set and reasons for variability,” Reza continued. “Beyond policies focused on pay, there are other disparities that factor into the gender pay gap, including the lack of women in leadership roles and in equitable support and promotion, that need to be directly addressed.”

Rita F. Redberg, MD, a cardiologist at the University of California, San Francisco and the editor of JAMA Internal Medicine, and colleagues wrote in a related editorial that the study was limited by a lack of data on salary disparities in “procedure-heavy subspecialties.” Redberg and colleagues added the study did not control for “factors such as work hours, length of training, productivity or research funding, all of which may further drive salary differences.

These limitations notwithstanding, Redberg and colleagues said they hoped that the study “inspires discussions” and “stimulates changes to improve gender equity and eliminate the gender pay gap.”

References:

Redberg RF, et al. JAMA Intern Med. 2021;doi:10.1001/jamainternmed.2021.3470.

Wang T, et al. JAMA Intern Med. 2021;doi:10.1001/jamainternmed.2021.3469.