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The Wall Street Journal (WSJ) responded to President Obama’s push for equal pay for women with an editorial by two employees of a right-wing think tank, the American Enterprise Institute (AEI). They claimed that gender disparity in salaries is a myth, easily accounted for by differences in hours worked, education, marital status, and occupational choice.

I’d like to share in some detail the results of a careful study that examined physicians’ salaries and found a persistent gender disparity that could not be explained by hours worked, education, occupational choice, part of the country, or race/ethnicity. A full PDF without paywall can be found here. This diary expands on my very brief summary of the paper in a comment to a DK diary on the WSJ editorial. More details follow below the Orange Stethoscope.

Study credentials: The study was published in 2010 in Archives of Internal Medicine, now JAMA Internal Medicine, a top-tier peer-reviewed medical journal. The authors are two PhD’s (a health economist and a biostatistician) and two MD’s (one in family medicine, one in internal medicine). All four are highly published experienced researchers (full disclosure: they are colleagues of mine; one is my husband.)

Study goal: The study was designed to compare hourly wages of physicians between primary care and other specialties, and also looked at the effects of factors such as race, sex, and region.

Study methods: The investigators used wage data from a nationally representative survey of more than six thousand physicians, and compared wages across 4 broad specialty categories and 41 specific specialties, estimating statistically the effects of specialty, age group (a proxy for experience), race, sex, region, and other factors that might influence wages.

Results: The paper reports that women physicians earned an estimated $9.45 less per hour than men in the same specialty and region, and of the same race and age. There were also differences between specialties, but these could not explain the sex difference. Nor could age/ experience or region of the country or type of practice.

Discussion points in response to the AEI editorial in the WSJ:
First, women physicians earn $9.45 less per hour than men, or approximately $18,900 per year (if they work a 40-hour week; many doctors work longer hours.)

This difference is not an artifact of working longer hours. The hourly wage is lower, so women who work the same hours as men earn less.

The difference is not an artifact of education. Every physician – male or female - has gone through college, medical school, residency, and advanced training as needed for their specialty.

The difference is not an artifact of occupational choice. Women pediatricians earn less on average than their male counterparts. Women neurosurgeons earn more than pediatricians, but less than male neurosurgeons.

The difference is also not an artifact of race, or where the doctors live, or whether they are working for Kaiser health plans or operating a small clinic. The researchers took those differences into account. The only AEI hypothesis not specifically examined was marriage. The proportion of women physicians who are married, though, is comparable to or slightly less than that of men, so unless married women are systematically paid less than married men who work the same hours, that hypothesis cannot account for the difference.

Bottom line: Salary disparities for women are real. Critical thinking at AEI is a myth.

Originally posted to Laurel in CA on Fri Apr 11, 2014 at 09:24 AM PDT.

Also republished by Community Spotlight.

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Comment Preferences

  •  Thanks so much for this, Laurel. (19+ / 0-)

    Facts are greatly appreciated, always. We need more of them to help push back against MSM's and Republican's abject denial of Reality.

    Sharing this everywhere and hope others do as well.

    There is something in us that refuses to be regarded as less than human. We are created for freedom - Archbishop Desmond Tutu

    by Onomastic on Fri Apr 11, 2014 at 09:31:09 AM PDT

    •  I'm not sure it's a denial of reality. I'm (9+ / 0-)

      beginning to think that some people simply do not see reality, as some people do not see color. What they see in their mind's eye is their only image and that's largely he result of superficial optics and not tested against tangible experience.
      Perhaps the reason we describe some people as "out of touch" is because their tactile senses are indeed dull. Perhaps they don't feel the ground under their feet and they don't perceive the environment making contact with their skin. In other words there's a sensory deficit which is masked by their verbal aptitude and a heavy reliance on repeating or mimicking what other people relate--strengths that would fit them nicely for participation in an organization.

      by hannah on Fri Apr 11, 2014 at 10:29:06 AM PDT

      [ Parent ]

  •  Excellent study but the right will ignore the (12+ / 0-)

    results of it. I've had arguments about this with some conservatives I know and their case always boils down to one word -- "babies". They'll call it different things, like the 'mommy track', but it always comes back to that for them. They think women have exactly one and only job -- to reproduce -- and everything else is a distraction. Jokes about women going to college to get their MRS, etc. are all part of it. So no matter how many studies or facts are presented to them they don't care because -- "mommy".

    GOP 2014 strategy -- Hire clowns, elephants, and a ringmaster and say "a media circus" has emerged and blame Democrats for lack of progress. Have pundits agree that "both sides are to blame" and hope the public will stay home on election day.

    by ontheleftcoast on Fri Apr 11, 2014 at 09:33:16 AM PDT

  •  If this is true (4+ / 0-)
    The researchers took those differences into account. The only AEI hypothesis not specifically examined was marriage. The proportion of women physicians who are married, though, is comparable to or slightly less than that of men,
    that could be highly significant and should have been looked at (considering that unmarried men earn 20% less than married men, it is reasonable that a similar dynamic could be in play here).
  •  I think it varies according to region. (10+ / 0-)

    My wife is paid exactly the same as her male hospitalist colleges. More, actually, now that she was elected group leader. My mother in law, another practice leader in a different state, is also paid more.

    However, we do have a family friend on the Island of Hawai'i who is a female physician. She found the discrimination against female doctors on the island was appalling. The best job she could get was working an emergency room in the remote district of Ka'u, where she was paid an astounding EIGHT DOLLARS AN HOUR. Her solution was to fly to O'ahu on alternate weeks and work in an emergency room there, where she made over a hundred dollars an hour. (As an aside, I don't recall ever seeing any female physicians on the Big Island in over thirty years there.)

    But a cautionary note: the average salary in the physicians studied was certainly over a hundred dollars an hour, so the less than nine percent (possibly far less) pay differential that it showed is actually far MORE equal than what women get in most occupations.

    •  I think it is changing, too, albeit slowly. (10+ / 0-)

      Medical schools are under pressure to respond to studies like this and like one carried out by NIH that shows disparities in medical researcher salaries. We do periodic studies to look for disparities (gender, racial/ethnic) in our own faculty and try to fix if possible. It's a lot better than it was years ago; disparities were way more than this when I started. But it takes awareness and effort. Also, our salaries are public record so there is social pressure!

      The study didn't have data enough to look at micro-regions like Island of Hawai'i versus Oahu, but I'm not surprised that there would be some differences. It may change with the next generation, with half or more of medical graduates being female, especially in family practice.

      And while some doctors make more than $100/hour, that's not true in rural areas or family practice specialties. The mean for family practice, as reported in the 2010 study, was $60/hr, for working an average of 51 hours per week (Table 2). Even surgeons averaged then around $92/hr. The highest salaries were for neurosurgeons ($132/hr.) So for family practice, that $9/hr deficit was more like a 15% difference at the time of the study.

      •  All those female medical students (0+ / 0-)

        will certainly ensure a change.

        I find the $60 an hour for family practice interesting -the reviews I've read put the average much higher, and of course the other specialties too. I can say for certain that none of the endless stream of job offers my wife receives every day are anywhere near that low. Perhaps recruiters are aware of the prevailing rates in different areas, and so don't bother people around here with such low offers?

  •  Excellent diary! (11+ / 0-)

    I knew that these claims were bullhucky, but couldn't rebut them with anything concrete.  You just did.  Thanks.

    It's the Supreme Court, stupid!

    by Radiowalla on Fri Apr 11, 2014 at 09:54:01 AM PDT

  •  I am so sick of this argument (10+ / 0-)

    There has been study after study like this one comparing starting salaries for men and women in various fields with the same credentials, education etc.  Disparity from the get go that just compounds over time.  It is not a hard concept to grasp. It is a hard reality to change.

    We view "The Handmaid's Tale" as cautionary. The GOP views it as an instruction book.

    by Vita Brevis on Fri Apr 11, 2014 at 10:36:28 AM PDT

  •  Laurel, I reviewed the JAMA Article, and it has a (6+ / 0-)

    problem in addressing pay disparity based on sex.

    The study was not designed to measure pay difference based on sex, while it is a variable in the analysis.  The study is best for analysis of pay differences based on disciplines which was the primary focus of the study, geographical differences, etc.. The report's text does not mention the regression factor for sex in the body of the text, it is shown only a number in a table.

    When doing a regression analysis there can be important factors that are hidden when not part of the data analyzed.  Consider a study of the cost of auto insurance rates based on auto color.  The study would show that red cars have higher rates than silver cars.  But what was actually occurring is that sports cars (high insurance rate) are disproportionaly red and SUVs (low insurance rate) are disproportionately silver because the type of cars was not in the study.  The difference in insurance rate was actually due to the type of car, not its color.

    Based upon anecdotal evidence, women are disproportionaltly represented in doctors working fewer hours than the median, and men are disproportionately represented by those working more than the median number of hours.

    While the study measures cash compensation per hour, it does not account for what is commonly found in labor markets where people are compensated by salary - average pay per hour is higher for those who work above median hours.  People are familiar with a similar practice with hourly employees receiving overtime pay.  One of the variables used in the regression calculation should have been hours worked per week but the study does not do this.

    Employees who work longer hours have a lower cost per hour to the employer in several ways - for benefits such as health insurance; cost of an office and dedicated equipment to the doctor, and management overhead for example.  It is common in labor markets that employees that have lower other costs to an employer are paid more than those that don't.

    This could have a significant change in the regression on the variable "sex."

    I would have also liked to see the data and analysis to include if the doctor worked in the private sector or public sector.  The public sector tends to pay "lower skilled" employees more than the private sector, while "high skilled" employees in the public sector are paid less than the private sector.  I don't know to what extent men/women are overrepresented here, but this should have been in the study.  

    I don't know if the study were done as discussed above would result in a higher or lower pay factor based on "sex."  When a computer calculation can produce the result I prefer to not make a prediction and let the calculation speak for itself.

    The most important way to protect the environment is not to have more than one child.

    by nextstep on Fri Apr 11, 2014 at 11:30:19 AM PDT

    •  Good to wake up on a Saturday morning and read a (1+ / 0-)
      Recommended by:

      post approaching study results using the statistical and analytical reasoning tools that humans have created for themselves over the centuries.  It shows no fear of what the answer might actually turn out to be.  The goal is simply to ascertain the truth, personal agreement or disagreement aside. I get a deep sinking feeling in my gut when I think that there is no set of facts, scientific or moral, that will ever change the dangerous mindset of anyone choosing to follow right wing leadership.

  •  Negotiation (4+ / 0-)

    Not all professionals work in lock-step salary contracts.

    When I was hiring professionals, in some cases, I was astonished by how little compensation some women would ask for...likewise, I was astonished by how much some men would ask for.

    For some women who were friends or family, I would suggest the market rate for their skills and they would still ask for less money.  Mind boggling.  I wouldn't have believed if I hadn't witnessed it multiple times myself.

    •  This is the beauty of this new Obama action (1+ / 0-)
      Recommended by:

      requiring posting by federal contractors of class salary data by gender and by race.  Transparency.

      I suspect once women begin to contrast and compare the truth about wage disparity, and that this is simply not a personal issue about individual qualifications or experience or education, but an actual disparity based on a class, the compensation demands will change.  

      Ledbetter will also allow women to then sue retroactively once that wage discrimination veil is pulled back.

      These two things are going to shake up the compensation field by requiring transparency.  Truthfully, employees have always had a legal right to discuss their salaries with each other - this is protected by the NLRB (even for non-unionized employees) - but Comp folks and bosses always discourage and caution employees not to discuss their wage rates - sometimes threatening employees with termination for doing so.  Why?  Because that secrecy hides an enormity of sins, prejudices, and inequities - individual and institutional.

      The next step would be to require the public posting of job descriptions and the metrics used to value qualifications, and the name of the person who made that valuation.

      "Out of Many, One Nation." This is the great promise of these United States of America -9.75 -6.87

      by Uncle Moji on Sat Apr 12, 2014 at 07:45:07 AM PDT

      [ Parent ]

    •  I hear that a lot, but I've also heard from (0+ / 0-)

      women who asked what they were worth, didn't get it, and later found out equivalent male colleagues DID get the money when they asked.

      We can't assume hiring managers prejudices out of the equation.

      © cai Visit to join the fight against global warming.

      by cai on Sat Apr 12, 2014 at 04:36:39 PM PDT

      [ Parent ]

  •  Anecdotally, (0+ / 0-)

    the people most desired in medicine are people without children. A spouse is ok, but the kids, no. Actually, gay men,  seem to do very well.

  •  pay (3+ / 0-)

    I dunno.  It would depend on how you look at it.  My colleagues (one male, one female) and I get paid the same for every code we bill.  The insurance companies and CMS don't look at gender in our billing.  My female associate has been a partner for two years while I have been a partner for 18 years and my male associate has been a partner for 23 years.  There is a seniority component to our compensation that makes a difference in our salaries.  If the female associate were male the same rules would apply.  In fact, when she became a partner we made the salaries more even due to the fact that we have to cover for each other more and more.  

    Does a scenario like this (seniority) explain some of the differnces seen?

    •  The study controlled for age, which over (0+ / 0-)

      populations should work out as equivalent to seniority, no?  Unless there are statistically significant numbers of Doogie Housers out there... or unless it takes women longer to be offered partnerships (also a gender issue)...

      © cai Visit to join the fight against global warming.

      by cai on Sat Apr 12, 2014 at 04:38:56 PM PDT

      [ Parent ]

  •  Laurel, I'd love to confirm that this study was (4+ / 0-)

    looking at overall renumeration, not salaries, per se.  It excluded federal employees (who would have been salaried), and was looking at net income.  Am I right?

    Since most doctors are paid on a fee for service basis, and most of the reimbursements are based on community rates, one thing that could explain this study's finding is that women take more time with their patients.  Frankly, that's a good thing for patients, and it's also consistent with some state-based data I've seen that shows that women have much lower rates of malpractice claims, regardless of specialty.

  •  Re (1+ / 0-)
    Recommended by:

    This $19k differential is on salaries that average around $175k. That makes the pay gap around 10%.

    So, this data again puts the lie to a supposed 23+% gap. Even taking the study at face value, the gap is 10%, not 23%.

    Here is another study about technology that demonstrates no detectable difference between male and female salaries when controlled for all variables.

    So, from the two data points we actually have, the male/female gap with all factors accounted for is somewhere between 0% and 10%. Not 23% or any other similar number.

    (-5.50,-6.67): Left Libertarian
    Leadership doesn't mean taking a straw poll and then just throwing up your hands. -Jyrinx

    by Sparhawk on Fri Apr 11, 2014 at 09:58:27 PM PDT

    •  You annualized numbers that were hourly (5+ / 0-)
      Recommended by:
      samanthab, ER Doc, Uncle Moji, sulthernao, cai

      and those hourly numbers were the "mean" for each discipline.

      Nobody has claimed that the wage disparity among female and male medical doctors was the national average of 77 cents on the dollar.

      The claim is/was that female MDs earn LESS than their mail counterparts and that was proven by the study.

      Statistically, the mean annual income was $187,857 over a mean work year of 47.3 weeks at a mean 53.1 hours. So the mean hourly is $74.81 and the stated disparity of $9.45 is 12.6 percent.

      That $9.45/hour difference spread across the mean 2,511 hours worked annually would be about $23,700, rather than the $18,900 example given for a 40-hour workweek--which is not typical.

      We're all just working for Pharoah.

      by whl on Fri Apr 11, 2014 at 10:56:55 PM PDT

      [ Parent ]

  •  Do wages motivate more than flexibility? (0+ / 0-)

    I think it can be hard to tease out some of the career decisions women make with regard to the flexibility they need to start and raise a family.  That's even changing somewhat for men as well.  

    Whereas in days of old physicians may have adhered to the endless days and nights at work and on call many have figured out that the compensation may not warrant the effort particularly in primary care and pediatrics.  So people adjust and choose practices or locations where they can combine their work life and home life with more flexibility.

  •  The hidden factors (3+ / 0-)
    Recommended by:
    nextstep, Samulayo, Sparhawk

    In my practice the average male MD was making more than the average female.  There were two very important factors which your study did not address.
    First, a part of the salary was productivity.  If you saw 30 patients a day you were paid more than if you saw 25 even though you worked the same hours.  The choice of work speed was up to the individual provider.
    Second the option to become a partner rather than an employee had a large impact on income.  All the males elected to become partners once they were eligible which did require additional administrative work on your "off" hours while some of the females chose to remain employees even though offered partnership.
    A female partner seeing the same number of patients as a male partner was paid identically.  But if you just looked at hours worked and gender of provider you would see a big difference.

  •  Why is rushing better than spending time? (2+ / 0-)
    Recommended by:
    fayea, cai

    I'm trying to understand why rushing patients through the office is better doctoring, a priori, than spending more time with them. I mean, maybe it is, but you just seem to be assuming that shorter appointments are better. As a patient, that's not my experience. A doctor who won't give me time to get my questions answer, or who won't make sure I understand what I'm supposed to do, is not a good doctor.

    Maybe the male doctors with the shorter appointments are better doctors. Maybe. But I'd like to see some justification, rather than just assuming faster is better.

    •  This comment was meant for blueash above, (2+ / 0-)
      Recommended by:
      fayea, cai

      who said that male doctors deserve to earn more money than female doctors because males rush their patients through their appointments to fit in more patients.

      •  they get paid per patient served (1+ / 0-)
        Recommended by:

        ...not per hour worked.

        Nobody claimed male docs deserved more money because they see more patients.  It is simply a function of the compensation plan for some health providers.

        As mentioned above, there are straight/fixed salary positions for MD's but those are mostly government positions.

      •  No I did not say that at all (0+ / 0-)

        The most productive MD was a female who rushed thru her patients and gave them whatever they wanted, antibiotics for colds, notes to never take gym because gym made them tired.  She was very loved by her patients and very in demand getting the highest ratings because she complied with every parental request. But seeing one additional patient every 2 hours is hardly rushing through.  

        What I thought I had clearly said was that in my practice the males made more per hour and that one factor was productivity and the large impact of becoming rather than declining to become a partner.  And that these differences, not gender is what caused the correlation of gender to income.

  •  *applause* (0+ / 0-)

    It's depressing enough watching Republicans tap dance around trying to pretend women don't worry their pretty little heads about earning less than men for the same work.  Watching some Kossacks immediately jump into pay equality diaries to blame women's education, field, hours, etc., for lower pay has been downright dispiriting.

    © cai Visit to join the fight against global warming.

    by cai on Sat Apr 12, 2014 at 04:28:30 PM PDT

  •  True... (0+ / 0-)
    Salary disparities for women are real.
    Thus it has always been (? even in matriarchal days?).
    And thus, by all current indications, it shall remain for longer than I care to think.

    So just quit bugging me about my position as a self-pitying drama queen.  My drama is real.

    "The only thing needed for evil to succeed is for good people to do nothing." Hannah Arendt

    by dharmasyd on Sat Apr 12, 2014 at 08:26:55 PM PDT

  •  Any doctor who gets paid by the hour... (0+ / 0-)

    isn't a doctor that I would want to see.

    •  Good luck finding a doctor (0+ / 0-)

      Every employment agreement I have seen gives a salary and a number of hours to be worked.  While one is not paid by the hour the calculations done in the study referenced did the expected of asking how much do you make and how many hours do you work and created a dollar per hour figure.  As a non-hourly professional there are no overtime protections, nor should there be. You work until you finish your job.  But the real test of whether you are paid by the hour will come when you tell your employer that you wish to cut back the hours by 25% but not have a pay cut.

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