To the Editor:
In 2017, for the first time, more women than men enrolled in medical school,1 marking a pivotal moment for setting and achieving reasonable goals for gender equity in medicine.
Inequity in compensation is a key target: The gender pay gap begins upon first hire,2 is not explained by part-time work or choice of specialty, and compounds over time. In a 2016 Wall Street Journal analysis, female physicians earned only 64.5% of what male physicians earned, the largest disparity amongst the 446 occupations examined.3 In its 2018 compensation report, Doximity reported an average physician gender gap of $105,000 (after controlling for factors like specialty, hours worked, and duration of practice).4 In no specialty did women make more than men, and the gap appears to have widened since the previous year’s report.
Systematizing pay equity for new residency graduates—at a point when there is little difference between candidates by objective accomplishments—is a straightforward, achievable first step towards transformative equity across a wide variety of specialties and practice types. This policy would be easy to monitor for compliance, and has such intuitive appeal that it may be required soon by some states.5 Since disparities in compensation may still creep in over time, a starting salary policy could be paired with regular audits to ensure that equity is sustained. Companies and other institutions unwilling to commit to this target would be hard-pressed to deny some degree of complicity in perpetuating inequity in a way that is systematically detrimental to women.
The modern suffrage movement in Europe, North America, and Latin America ended only 40 years ago, yet it is already difficult to imagine a time when women didn’t have the vote—or even why they wouldn’t. Pay inequity, too, is a relic that should be placed in our forgotten past.
Esther K. Choo, MD, MPH
Associate professor, Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon; echoMD@gmail.com.
David R. Bangsberg, MD, MPH
Founding dean, Oregon Health & Science University–Portland State University School of Public Health, Portland, Oregon.
1. More women than men enrolled in U.S. medical schools in 2017. AAMC News. https://news.aamc.org/press-releases/article/applicant-enrollment-2017
. Published 2017. Accessed September 27, 2018.
2. Lo Sasso AT, Richards MR, Chou CF, Gerber SE. The $16,819 pay gap for newly trained physicians: The unexplained trend of men earning more than women. Health Aff (Millwood). 2011;30:193201.
3. Adamy J, Overberg P. Women in elite jobs face stubborn pay gap. Wall St J. May 17, 2016. https://www.wsj.com/articles/women-in-elite-jobs-face-stubborn-pay-gap-1463502938
. Accessed September 27, 2018.
4. Doximity 2018 physician compensation report: Second annual study. https://blog.doximity.com/articles/doximity-2018-physician-compensation-report
. Published 2018. Accessed September 27, 2018.
5. Marum A. Oregon Senate passes Equal Pay Act of 2017. Oregonian. May 8, 2017. http://www.oregonlive.com/politics/index.ssf/2017/05/what_the_oregon_equal_pay_act.html
. Accessed September 27, 2018.