Renee Butkus, BA; Joshua Serchen, BA; Darilyn V. Moyer, MD; Sue S. Bornstein, MD; Susan Thompson Hingle, MD; for the Health and Public Policy Committee of the American College of Physicians *
Disclosures: Dr. Hingle reports receiving a stipend for her role as chair of the ACP Board of Regents outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3438.
Requests for Single Reprints: Renee Butkus, BA, American College of Physicians, 25 Massachusetts Avenue NW, Suite 700, Washington, DC 20001; e-mail, firstname.lastname@example.org.
Current Author Addresses: Ms. Butkus and Mr. Serchen: American College of Physicians, 25 Massachusetts Avenue NW, Suite 700, Washington, DC 20001.
Dr. Moyer: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Bornstein: Texas Medical Home Initiative, 3111 Beverly Drive, Dallas, TX 75205.
Dr. Hingle: Southern Illinois University School of Medicine, 801 North Rutledge Street, PO Box 19628, Springfield, IL 62794-9628.
Author Contributions: Conception and design: R. Butkus, J. Serchen, D.V. Moyer, S.S. Bornstein, S.T. Hingle.
Analysis and interpretation of the data: R. Butkus, J. Serchen.
Drafting of the article: R. Butkus, J. Serchen, D.V. Moyer, S.T. Hingle.
Critical revision of the article for important intellectual content: R. Butkus, D.V. Moyer, S.S. Bornstein, S.T. Hingle.
Final approval of the article: R. Butkus, J. Serchen, D.V. Moyer, S.S. Bornstein, S.T. Hingle.
Administrative, technical, or logistic support: R. Butkus, J. Serchen, S.S. Bornstein, S.T. Hingle.
Collection and assembly of data: R. Butkus, J. Serchen, S.T. Hingle.
Women comprise more than one third of the active physician workforce, an estimated 46% of all physicians-in-training, and more than half of all medical students in the United States. Although progress has been made toward gender diversity in the physician workforce, disparities in compensation exist and inequities have contributed to a disproportionately low number of female physicians achieving academic advancement and serving in leadership positions. Women in medicine face other challenges, including a lack of mentors, discrimination, gender bias, cultural environment of the workplace, imposter syndrome, and the need for better work–life integration. In this position paper, the American College of Physicians summarizes the unique challenges female physicians face over the course of their careers and provides recommendations to improve gender equity and ensure that the full potential of female physicians is realized.
Appendix Table. Case Studies
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Alan R. Ertle, MD, MPH, MBA
Mercy Medical Group, Inc.
May 23, 2018
Gender Equity. Where do the Issues Remain?
I read the article by Butkus, et. al., with great interest. As a medical group administrator (medical director, CEO, CMO) for over 20 years, the generic statement about male providers making more than women providers seemed to be uninformed hyperbole. In my last four positions, physician compensation has been largely (about 90%) based on productivity with a consistent dollar value per work RVU for each specialty. These dollar per work RVU values have been based on large annual surveys (MGMA, AMGA, ECG, Sullivan Cotter Large Group). In our organizations, there has been no way to financially disadvantage women physicians relative to men for the same work in the same specialty, particularly given that the physicians have been payer agnostic and were not at risk for payer mix or collections. The primary reference cited regarding the disparity in incomes was the “Medscape Physician Compensation Report 2017.”1 Reviewing slide 13, it indicates precisely what was reported regarding male versus women primary care physicians. However, what it fails to indicate is the sample size for each cohort and what proportion of each specialty was within each cohort. If there were more women pediatricians (often the case) and more male internists, this could account for the difference. Slide 13 also doesn’t indicate whether there were more women working part-time (often the case) compared to men in the sample. These same issues exist for slide 14 related to men versus women specialists. This makes interpretation of the “study” (a 43-slide deck with no source data) virtually impossible. The authors cite an article by Jena, et. al. which fails to take into account significant skew to the left with outliers in compensation and reports on mean incomes as their measure of central tendency, when it seems that median values would have been far more appropriate.2 What may be more important in academic settings in not the difference in salary, per se, but the differences in opportunities for advancement and leadership available to women, leading to those salary differences.3 This position paper is rife with confirmation bias in interpreting the cited, and sometimes questionable, sources. I believe in gender equity. This position paper should be rewritten with more objectivity, particularly as it relates to potential income disparities, to find out where the problems truly persist. 1. = citation 3 in their article2. = citation 4 in their article3. = citation 5 in their article
Susan Thompson Hingle, MD, Greg Kane, MD, Renee Butkus, BA; Joshua Serchen, BA; Sue S. Bornstein, MD
ACP Position Paper
June 26, 2018
Although progress has been made toward gender diversity in the physician workforce, disparities in compensation persist. Numerous studies, looking at gender pay disparities from different perspectives, have contributed additional evidence that the gender pay gap in medicine is indeed persistent and real. (References 1,2 and 3) Dr. Ertle highlights that there are practices where “pay for productivity” predominates and this has, where applied fairly, helped level the playing field for compensation across genders. RVU based systems, however, do not eliminate gender pay disparities. Linzer et al highlight that patients have differing expectations of female versus male physicians. (Reference 4) Our paper, also emphasizes that even in pure work RVU (wRVU) systems, much of the important work of women physicians is undervalued as they spend more time counseling patients, providing preventive care, and performing office-based GYN procedures, which tend to have lower reimbursement and lower wRVU relative to the time invested. Where compensation systems are not predominately wRVU based, base compensation and compensation growth are often lower for female physicians relative to male. For numerous complicated reasons, women have a lack of advancement and leadership opportunities, which additionally contributes to the pay differential. It is unclear why but women are also less successful than men in renewing R01 grants from the National Institutes of Health (Reference 5) The medical profession and our patients benefit greatly from a diverse physician workforce. The evidence demonstrates that the problem does truly exist and the paper was written to help move the discussion to solutions. Rather than arguing about the validity of the evidence, a concerted effort must be made to eliminate the imbalance in compensation and career advancement opportunities and provide a more inclusive environment to realize the full potential of all physicians in the workforce. References:1. Freund KM1, Raj A, Kaplan SE, Terrin N, Breeze JL, Urech TH, Carr PL.Inequities in Academic Compensation by Gender: A Follow-up to the National Faculty Survey Cohort Study. Acad Med. 2016 Aug;91(8):1068-73. doi: 10.1097/ACM.0000000000001250.2. Weaver AC1, Wetterneck TB2, Whelan CT3, Hinami K4. A matter of priorities? Exploring the persistent gender pay gap in hospital medicine.J Hosp Med. 2015 Aug;10(8):486-90. doi: 10.1002/jhm.2400. Epub 2015 Jun 30.3. Weeks WB1, Wallace TA, Wallace AE. How do race and sex affect the earnings of primary care physicians? Health Aff (Millwood). 2009 Mar-Apr;28(2):557-66. doi: 10.1377/hlthaff.28.2.557.4. Linzer M1, Harwood E2. Gendered Expectations: Do They Contribute to High Burnout Among Female Physicians? J Gen Intern Med. 2018 Jun;33(6):963-965. doi: 10.1007/s11606-018-4330-0. Epub 2018 Feb 12.5. Kolehmainen C, Carnes M Who Resembles a Scientific Leader-Jack or Jill? How Implicit Bias Could Influence Research Grant Funding.Circulation. 2018 Feb 20;137(8):769-770. doi: 10.1161/CIRCULATIONAHA.117.031295.
Butkus R, Serchen J, Moyer DV, et al, for the Health and Public Policy Committee of the American College of Physicians. Achieving Gender Equity in Physician Compensation and Career Advancement: A Position Paper of the American College of Physicians. Ann Intern Med. [Epub ahead of print 17 April 2018]168:721–723. doi: 10.7326/M17-3438
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Published: Ann Intern Med. 2018;168(10):721-723.
Published at www.annals.org on 17 April 2018
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