Calling All Female Physicians

Here is an article in Money at CNN called “The gender pay gap for women doctors is big — and getting worse”.  I need help to understand this. Here is what it said:

They also attended medical school and underwent the same years of rigorous training, but female doctors in the United States are earning significantly less than their male peers — and the pay gap is only growing wider.

Women doctors earned an average of 27.7% less than their male counterparts in 2017, according to a new survey of 65,000 physicians by Doximity, a social networking platform for health care professionals.

That’s an average of $105,000 less a year.

Here is my confusion. I used to work for two different hospital systems. There were times that certain doctors were 100% salaried because they were needed desperately in the area.  For example, a pediatric neurologist or a cardiac thoracic surgeon were hired to offer these services so they guaranteed them a good salary.  Maybe, because I don’t know, female physicians are getting less salaries in these situations.  In fact, the study showed that the specialties with the largest pay gaps of about 20% included hematology, occupational medicine and urology.

The problem, however, is that these positions are very small compared to the rest of the doctor population like family medicine, internal medicine and pediatrics.  The rest of these employed physicians are guaranteed a certain salary that is normally low with bonus structures built in using work RVUs and other metrics.   If that is the case then how is gender pay an issue for the majority of us?  I do not want to come off too negative or cold here because I am not trying to, but help me understand this pay difference that this study talks about?  Please comment here and explain it to me.

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  15 comments for “Calling All Female Physicians

  1. arf
    June 7, 2018 at 5:03 pm

    Argument number seven bazillion why noncompetes in medical employment contracts should be legally null and void and declared unethical in no uncertain terms by medical and specialty organizations.

    To the extent that this exploitation of female physicians exists, the female doc needs to be able to go across the street and work for the competition.

    And if the employer KNEW the female doc was able to do this, the employer might be less likely to exploit the female physician in the first place.

    I say the noncompetes hurt female physicians worse than males.

    IF there’s anything to the stereotype nowadays, the male physician has a wife with a more “portable” occupation, or is home with family. Male doc moves out of exclusion radius of noncompete.

    Female physician, if married, has a spouse with a less “portable” occupation, and female doc is more likely to be locked into a certain area.

    The employer knows that, and acts accordingly.

    • Chris
      June 12, 2018 at 1:54 pm

      The only rationale that an employer has to have a non-compete in your contract is that they guarantee your salary at the outset of your employment. So basically they take a loss on your first year or two and then they want to recoup the investment. When you negotiate your renewal of your contract you just say you won’t sign one with a non-compete clause. At that point if you have successfully established your practice you hold all the cards. The employer doesn’t want to start the whole process over and rebuild the practice.

  2. chris
    June 7, 2018 at 12:15 pm

    The pay-gap story is largely driven by female actors in Hollywood complaining that they don’t get paid enough. Ironically there is a good reason for the pay-gap in Hollywood and it is that male actors bring in way more money at the box office than female actors. One look at the list of top box office gross by actors shows only 9 women on the top 50 and only 1 in the top 20. I guess you can blame the movie-going public for being sexist, but there it is.

  3. Sir Geon of Bones
    June 6, 2018 at 5:49 pm

    Get Rich Scheme:
    Start a new multispecialty clinic. You are the medical director
    Hire only female physicians
    Offer the best physicians a raise as an inducement
    Give them a 20% raise, taking them from 70% of a male physician salary to 84% of a male physician salary
    Keep the other 16% for yourself in addition to your normal salary as medical director
    Collect whatever the insurance companies are paying everybody else

  4. Sarah Elert
    June 6, 2018 at 5:17 pm

    Forget about part timers and gaps for baby raising. That’s not the issue. We are talking about wage gap for equal experience, proficiency, and patient contact hours/RVU’s as our male partners.

    I am a lady doc. I worked 6 years at a practice where we all got the same wage, paid by the day for pre-agreed upon “full clinic”.

    I now work with a group where I was told all docs work full production, but found out 2 years into it several docs had been on a salary guarantee for years, and several others had a hybrid of base plus production.

    I think the wage gap is real, and is more due to 2 things: 1) women do not negotiate as hard as men for money, as many of us were raised to make people happy, not to win; and many of us carry that subconscious bias into a negotiation, and 2) Even employers that say “everyone here works on production so there is no need to worry about negotiating a salary” may be lying. And often are.

    I consider everything a negotiation, even if I am told “this is the standard contract, its the same for everybody” . I will walk away if it seems too low. Hiring is all about supply and demand, and whoever is hungrier (employer or employee) will get the better deal.

    • chris
      June 7, 2018 at 11:43 am

      I guess I don’t really understand. If you are on cash production or so much money per RVU how can your employer pay the male docs more than they deserve unless they are cooking the books and thus committing fraud?

      First off, if you want to maximize your income as a physician you have to have at least a little bit of knowledge of the accounting side of things and pay attention to it. For the past 9 years I have been employed by a large hospital corporation and I personally have found accounting and billing errors on their part that amounted to well over $100,000 during my tenure. My regional manager actually got fired I think largely due to one $90,000 dollar error that made me threaten to quit.

      Furthermore it is my opinion that paying you by RVU is used by employers for 2 purposes: 1) as a loophole in STARK when they want to pay docs (usually specialists that perform very lucrative procedures) more than they personally bring in 2) to pay docs (usually primary care) less than they bring in. Using RVUs obscures the connection between work performed and reimbursement. I think cash basis is the only way to go for a PCP (unless you are lazy, then go work for the VA). Then you know exactly what you are bringing in and what you are spending on expenses. If your employer wants to take a big chunk of the profit of your practice…refuse. They need you as a referring doctor to feed the parts of the hospital that make the money. Of course you have to make yourself valuable to the hospital. If you are constantly referring out, using outside lab or x-ray services, sending your patients to another hospital you are going to wear out your welcome soon. I have one specialist in my market that I don’t refer much to and my hospital knows it. Unless you are geographically anchored somewhere it is really a sellers market. I get unsolicited job offers constantly so I don’t get the people who are complaining that they have no bargaining power.

      In the short term you can get an employer to pay you more than you bring in in the form of a salary, guaranteed salary or hourly rate but they will replace you with someone more productive after a while if you are not profitable or they will skim off your profit if you are in the black.

  5. Amy Holmes
    June 5, 2018 at 7:46 pm

    I am a female physician, and there is no difference in my pay than my male colleagues. I don’t feel undermined in any way.

  6. Randy
    June 5, 2018 at 10:30 am

    I am not a female physician but based on my career I am always surprised by the discrepancy in pay. I started out in the Air Force where everybody was paid based on rank. Then I went into a large group where everybody was paid by the same formula.

    Now I’ve been solo for about 16-17 years, and I get paid what Medicaid, Medicare and insurances will pay me, which should be the same male or female. Since I am solo I have very little negotiating leverage and am a lousy negotiator anyway. Despite that I generally make well above the average for FP and way above the average for FP women physicians.

    I suspect the difference is women physicians tend to make different life and practice decisions, and that is reflected in their pay.

  7. Stephen O'
    June 5, 2018 at 10:08 am

    Cashing in the Pink Discount is one of the four propaganda challenges of any workplace. They are:
    1) Discount salaries by 20% by “equality of opportunity.”
    2) Automating what should not be automated.
    3) Offshoring work – domestically or in foreign countries.
    4) Harvesting quality for cash.

    These are all propaganda challenges. They all represent legitimate business improvements, if the goals used duplicitously were actually genuine. But they are not, and have not been very often.

    When a profession or job is to provide the “pink discount,” it is touted as the object of equality. Perhaps a century ago, we have forgotten that elementary school teaching was a man’s profession. The 1900’s cycle of feminism brought women to the classroom; and the status and salaries were promptly reduced.

    The mechanical Dr. Watson as super-doctor has been touted since the postwar years (WWII). It has not yielded much for replacing doctors. It has produced amazing things when working with scientists and doctors, though.

    Importing Drs. from Elbonia to the US, or offshoring work to Elbonia, has always been there. Interestingly, as the quality of medicine soars abroad, it is less of a magic cure than before.

    The fourth method shows what quality measures are really for. If the outcomes are too good too often, they are too expensive. I have seen corporations mercilessly target quality, under the rubric that lowering quality will lower costs. Whether it works or not, is anyone’s guess. It rarely seems to.

  8. Chris
    June 4, 2018 at 2:29 pm

    Its the same old BS on the sex pay-gap. They never take into account that in these studies the women work fewer hours and have gaps in their careers. Mostly in medicine physicians “eat what they kill”, so its just a matter of how hard you work. In my experience there are many more female compared to male physicians who only work part-time. Plus there are more female physicians in lower paying specialties.

    We had an employed part time female doctor in the first practice I belonged to. She worked only 3 days a week so she could spend more time with her kids and on her days in the office she would only see about 3 patients an hour. We all paid the same percentage of our receipts for expenses and she never had to take call, so she was really getting a sweet deal out of that and then she had the gall to complain that she wasn’t getting paid enough. I liked her personally but I was all for firing her and taking all her patients for myself.

  9. Jamie
    June 4, 2018 at 2:22 pm

    There is this, I was hired by a hospice company last year and they offered me $50 less per hour than the male physician. I’ve been a physician for 19 years. I am not sure if it was due to gender, or that he asked for more several months before when he was hired. I was hired second. We were hired to split the med director job 50/50. I looked at his medical school grad date, credentials, board certs, fellowships, experience and there was no difference between us. So I asked for $50 more per hour and got it. But the only reason I knew about the gap was because the innocent nurse coordinator showed me his timesheets so I could understand how they paid call and how they paid in 15 min increments etc. And from that, I discerned the difference. Glad she gave me those timesheets and glad I asked for more. Of course, I did not disclose what I had seen on those timesheets.

    Here is a second experience. I was working alongside another doc in a private practice. He was hired as a full time physician contractor first by 10 months, but had no leadership role. I was hired second to the same full time physician contractor job. Anyway, eventually, I was carrying a bigger panel than him by 33%. Around that time, I found out he was also making $15K per year more than me. So I asked for $15K more per year and got it. Not sure if that initial gap was due to gender, but glad I found out that he was making more so I knew to ask for it. He was there 10 months longer, but was junior to me by experience by about 11 years. Then I was also told not to discuss pay in that organization. I now have founded and run my own clinic and in my clinic there is transparency of pay and my employees are allowed to discuss pay as per the employee handbook.

  10. RicDoc
    June 4, 2018 at 10:59 am

    I have not read that study, but first off, it is self-reported data. Secondly, I’m not sure if other factors beside gender were weighed, such as: number of days worked, patients seen per day, procedures performed, complexity of procedures, and practice ownership. If any of these parameters vary, then pay varies (whether by gender, specialty, age, et cetera).

  11. Erica
    June 4, 2018 at 10:27 am

    In January I took a FM contractor position at a rural medically underserved clinic for three months, and they gave me what I consider to be a fair contractor wage. The 2 male physicians at this job are contractors. The two female physicians at this job are employees. At the end of 3 months I wanted to renew as a contractor. This company would only let me stay on if I became an employee. My wage went from $150/hr to $95/ hr…the men were allowed to stay contractors at contractor wage. I went from the man wage to the female wage in front of my very eyes. Let’s hear it for the pay gap!

  12. Taz
    June 4, 2018 at 8:14 am

    About 10 years ago I began working locum tenens. I would accept whatever the recruiter told me was the going rate. As I became more experienced, I began to sense that I was being lowballed. It was confirmed at one site in New York when I found out that most of the male docs with whom I worked were making $30/hr more than me. That ED used LT docs from several companies, so it wasn’t just my company. The recruiter blatantly lied and told me the pay I was getting was the highest they would pay. When I was initially hired at another CMG run facility, I had negotiated a compensation amount the recruiter(a female), refused to pay. After a year, she called me and acquiesced. Not because she had a change of heart, but because it was a rural hospital that really needed ED physicians. At that point, I was the highest paid ED physician in that department, even more than the ED director. The recruiter blacklisted me so that I could work at no other facility staffed by that ED in the region in which I lived. 4 years later they decreased my pay unilaterally and without a contract. I thought it was an error. It wasn’t. I contacted my attorney. He informed me that I could sue and would most likely win back pay—but I would also lose my job. He also told me I could keep my mouth shut and keep my job. I kept my mouth shut. As angry as I was, I gouged them when they needed me to cover in an emergency. I got paid a few thousand in bonus pay to come in at the last minute when they could find no other doc. This is still occurring today. I recently applied at a low volume, very rural hospital in CA. The recruiter knew my credentials, residency trained, board certified EM doc with nearly 23 years experience and no lawsuits. The gold standard. I was offered $67/hr.

    • EG
      June 4, 2018 at 8:16 pm

      In CA?? That’s a joke. Even rural Texas pays more than that, to first time, non-ED boarded, female physicians … and TX has much lower cost of living and typically lower wages than elsewhere. Are you sure they didn’t miss a digit in front of the 67?

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