Women in primary care earn less than men

Female primary care physicians make 22% less than their male counterparts, even after adjusting for differences in practice and personal characteristics, according to a report from the Center for Studying Health System Change.

Ha T. Tu, co-author of the report, found that female primary care physicians' salaries lagged behind inflation and that the income difference between male and females was widening -- from 16% in 1995 to 22% in 2003.

"Is there gender discrimination going on? I don't feel comfortable with that conclusion," Tu said. Clearly, though, she said, something is at work.

The income adjustments she and her co-author made included specialty, years of experience, board certification, international medical graduate status, average hours worked, practice setting, proportion of Medicaid and capitated revenue, and practice ownership status. However, there may be other factors that could translate into income differences, Tu said.

Edward Salsberg, director of the Assn. of American Medical Colleges' Center for Workforce Studies, also hesitated to cite gender discrimination for the pay difference.

Female physicians may be trading income for positions with greater flexibility, he said, citing data from an AAMC survey of physicians younger than 50. The survey found most female physicians have life partners who work full time, while the majority of male physicians do not. Perhaps, Salsberg suggested, these women do not feel as pressured to bring home a big paycheck. The survey also found that female doctors put a high value on personal life and lifestyle, another reason they may be making choices that swap income for more flexibility.

Pediatric geneticist Beth Ann Pletcher, MD, chair of the American Academy of Pediatrics' work force committee, is not sure the salary difference can be explained away so easily.

"I'm not buying that," she said, citing the lack of advancement of women in academic medicine compared with men. "There are women in my department who have been here for 20 years who are still assistant professors. Very few men would still be at that level in that period of time."

Data on PhD medical school faculty at some institutions has shown a gap between salaries of men and women in positions of equal rank and responsibility. For example, the Pennsylvania State University College of Medicine in Hershey hired an outside consultant who found gender-based income discrepancies.

A university spokesman said the institution responded by eliminating these differences. Eight female faculty members, however, filed a lawsuit this spring claiming that the medical school had discriminated against them by paying them less than their male counterparts and shortchanging them on bonuses and pensions. The university declined to comment on the lawsuit.

Ob-gyn Erin Tracy, MD, MPH, said gender disparities in pay may not be the first topic among physicians in the lunch room, but that does not mean it is not an issue. "It is something that seems so untenable that people assume it's not the situation at their institution, but when they pull the data, it may show otherwise."

Dr. Tracy is speaking on her own behalf, but she is a member of the American Medical Association Women Physician Congress governing council. The AMA passed a resolution at its June Annual Meeting to study gender disparities in physician income.

"It's important for everyone to look at their own data to decide if it's a problem that needs to be addressed," Dr. Tracy said.