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Last Monday, Sophie Balzora’s group texts with fellow women doctors started blowing up with “a lot of angry, red-faced emojis,” she said.

The messages followed the release that same day of a study in the journal Health Affairs that found that women doctors in the United States earn an estimated $2 million less than men over the course of their careers — and that the pay gap begins the first year they practice.

The research relied on self-reported salary data that more than 80,300 physicians submitted between 2014 and 2019 to Doximity, a “professional medical network for physicians” that claims to reach more than 80 percent of U.S. doctors. Researchers controlled for factors that may influence pay, including patient volume, specialty, practice location and hours worked, the study notes. It did not account for race or transgender or nonbinary identities because Doximity does not collect that data, according to Ishani Ganguli, a primary care doctor and one of the study’s co-authors. (Prior research has found that White men in medicine earn more than men of other races and than all women, and that White women in medicine tend to earn more than women of other races.)

To many women doctors, the findings didn’t come as a surprise: They know the pay gap exists from their own lived experiences, and other studies have shown similar disparities for years, noted Balzora, a gastroenterologist and clinical associate professor in the department of medicine at New York University’s Grossman School of Medicine.

But what surprised her and the women in her group texts, she added, is that no systemic solutions seem forthcoming: “The findings are not surprising, but it’s still infuriating every time employment data comes out — because it’s like, ‘Why is nothing being done about this already?’”

Sophie Balzora. (Courtesy of Sophie Balzora)
Sophie Balzora. (Courtesy of Sophie Balzora)

The recent data provide researchers with insight they can build on to research how best to close the pay gap for women in medicine, according to Ganguli, who works as an assistant professor at Harvard Medical School and a practicing internist at Brigham and Women’s Hospital in Boston.

“The critical next step is research around solutions,” she said, adding that she is part of a separate group of researchers studying how different ways to pay doctors might impact the gender wage gap.

While women doctors wait for systemic change, many are trying to spur progress in the field themselves, by working to bring more women and people of color into their profession and teaching them to advocate to be paid what they are owed.

In February of this year, Balzora co-founded the Association of Black Gastroenterologists and Hepatologists, a group that aims to develop a pipeline of, and promote networking opportunities for, Black doctors in those specialties. As of 2018, Black GIs made up only 4 percent of GIs overall, according to the Association of American Medical Colleges (Black women GIs make up only 1 percent of GIs across the country, that data also shows).

Among ABGH’s 11 co-founders, nine of whom are Black women, “there are definitely people who have had very different starting salaries, or their salaries have been less despite them having more experience than people who are just starting out who are White males,” she said. In February, the group will host a February financial literacy seminar for its more than 150 members, Balzora added.

A study published in July, in the journal JAMA Internal Medicine, analyzed 21,905 faculty across 13 internal medicine specialties. It found that while the specialties of gastroenterology, cardiology and critical/intensive care paid better overall than the others studied, they also “demonstrated the largest gender disparities in both representation and salary.”

The study published last week also notes that income gaps vary by specialties: Women surgeons face the largest disparity, at $2.5 million, followed by nonsurgical specialists, at $1.6 million, and primary care physicians, at $900,000.

Some of these disparities can be attributed to “the gender composition of these specialties,” according to Ganguli, the study’s co-author.

Surgical specialties tend to be much more male, so you can imagine that their power structures are different — the people who are making decisions are more often male, compared to a field like primary care, where it is a bit more balanced,” she said.

But women doctors say they experience patriarchal power dynamics across medicine.

Shikha Jain, a practicing hematologist and oncologist, said that when she was interviewing for jobs earlier in her career, a male interviewer asked her if she was married. When she replied that she was, she said, he followed up with, “Does your husband work?”

“I said, ‘Yes, he’s a physician,’ and his response was, ‘Well then, it doesn’t really matter how much money you make, because you have a husband who is bringing home money as well,’” said Jain, who is also an assistant professor of medicine in the division of hematology and oncology at the University of Illinois Cancer Center in Chicago.

Shikha Jain. (Steve Gadomski)
Shikha Jain. (Steve Gadomski)

The exchange left her “stunned,” she said. But the combination of her age and her lack of a network of other women starting out in medicine meant she didn’t know how to advocate for herself, she said: “The reason I didn’t know how to respond was because I had never heard of these things happening.”

That lack of support she felt is part of what inspired her to start Women in Medicine, an organization that aims to advance gender equity in medicine. The 70-member group — whose annual summits, launched in 2019, have seen up to 450 attendees, according to Jain — aims to provide education, mentorship opportunities and leadership development opportunities for women in medicine “at all levels of their careers” and across specialties.

Signs at the Women in Medicine Summit in Chicago in 2019. (Krishna Jain)
Signs at the Women in Medicine Summit in Chicago in 2019. (Krishna Jain)

Given that “medicine is very hierarchical,” Jain said, bringing women together at different points in their careers is particularly important — and it’s effective, she added, pointing to one member of Women in Medicine who she said was able to negotiate for a larger title and higher salary after implementing negotiating skills she learned from the group.

Another initiative with similar goals is the Women’s Wellness through Equity and Leadership Program (also known as WEL), an 18-month-long program that six leading U.S. medical organizations formed in 2018 to provide women physicians with networking and leadership training. The 18 members of the program’s first cohort “reported improved confidence, knowledge, and leadership skills” — particularly related to negotiation and organizational change, according to a program assessment.

The group’s second cohort, of 50 women physicians, launched this past spring, according to Susan Hingle, a member of the program’s steering committee, a practicing general internal medicine physician and a professor of medicine at the Southern Illinois University School of Medicine.

Like Jain, Hingle said she also faced gender-based barriers early in her career, adding that even before the publication of last week’s study, she had estimated she had lost between $1.5 to $2 million over the course of her career compared to the salaries of men she knew. She attributes that in part to the fact that the hierarchy in medicine starts early on, she said: “What you do early on in your career, that really creates the trajectory.”

The study released last week found that, in their first year of practice, male physicians earned an average income of $168,687, compared to women’s average of $136,377, and that by the 10th year of practice, men earned an average of $41,062 more than women.

While the study didn’t specifically investigate why the gap both originates and increases in that initial decade, Ganguli, the co-author, attributes it to various possible factors rooted in sexism — including differences in the starting salaries men and women successfully negotiate and women possibly “bearing a disproportionate burden of domestic and family responsibilities,” particularly if they have young children in their early career.

“There’s a lot happening in those early years of practice that can contribute to a large gap,” she said.

The paper notes that “policies that eliminate those [salary] differences early on may lead to reduced differences over time as well.” According to the women physicians who spoke to The Lily, these could include pay transparency and paid family leave, as well as increased mentorship opportunities for women and tracking who gets leadership roles within organizations, they said.

“There’s this fallacy that it’s individual choices or family choices, and that’s what leads to a pay gap — it’s structural issues,” Balzora said.

Men’s allyship is also key to fostering greater equity in medicine, given their dominance in leadership roles, Jain noted. Next spring, Women in Medicine will host a course for men in health-care leadership positions focused on how they can become better allies to the women they work with.

Doctors are paid well overall, Ganguli acknowledged, pointing to the study’s finding that men earned an average income of $8.3 million over a 40-year career, while women earned about $6.3 million. But “gender biases and disparities are still a huge issue, and should not exist,” she said.

Balzora, and the women in her group texts, agree — especially given that the pay gap exists across professions, with Latinas being the lowest paid group, and Black and Native American women also earning less than White and Asian women.

“Regardless of whether you’re making a million dollars a year or you’re making $30,000 a year, you’re still losing income because of the basic fact that your gender is one gender and not another,” she said.

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