Male rheumatologists earn about 16% more than their female counterparts, according to new compensation data from Medical Group Management Association (MGMA). Although the data seem indicative of widespread gender disparity, experts say a deeper dive is necessary to better understand the phenomenon.
“There’s a lot of nuance to the data,” says Todd Evenson, MGMA’s chief operating officer.
To be sure, male rheumatologists earn more. Their compensation was $276,138 in MGMA’s 2017 Physician Compensation and Production Survey, compared with $237,645 for female rheumatologists. That’s a 16.2% difference, or $38,493. Males across specialty fields reported earning 37% more than females in the same practice area, the report continued.
Male rheumatologists also work more, according to the data. MGMA reported that male rheumatologists generated 4,944 median relative-value units (RVUs) vs. 4,155 RVUs for female rheumatologists. That difference, 19%, outpaces the compensation differential.
“There is clearly a disparity, if you’re looking only at the aggregate data and bifurcating by gender,” Mr. Evenson says. However, “there are multiple dimensions that truly do influence overall total compensation. Adding the element of production results in greater compensation parity.”
Example: For male and female rheumatologists with less than 4,000 RVUs, the pay differential was 12.4%, according to data provided by Mr. Evenson. Men and women who generated 4,000–6,000 RVUs had a differential of just 5%. Only male respondents reported generating more than 6,000 RVUs.
“I acknowledge there are still realities around environments [in which] the gender gap exists, and it’s unacceptable when that is the case,” Mr. Evenson says. “There is latent time between efforts in discriminatory law, generational tendencies and compensation methodologies before we will see the expectation of equity in the aggregate data. But digging into the data suggests we are moving in the right direction.”
Anne Bass, MD, chair of the ACR’s Committee on Rheumatology Training & Workforce Issues, says the number can be jarring at first glance. But it’s important to put the number in the context of how male and female rheumatologists work differently. And although Dr. Bass is not one to put too much stock in one annual report, she agrees longstanding gender inequality with regard to compensation is pervasive in medicine.
In rheumatology, the issue will likely be only more acute in the coming years as the specialty is becoming a female-dominated field. According to the ACR’s 2015 Workforce Study of Rheumatology Specialists in the U.S., 57% of all rheumatologists who treat adult patients are projected to be female. As of the report, 68% of rheumatologists who treat pediatric patients were female.1
But despite the growing prevalence of female practitioners in rheumatology and healthcare as a whole, compensation models remain mostly tied to RVUs and other measures of productivity. That connection works against female rheumatologists, who typically work fewer hours than their male counterparts. Information from the 2015 State Physician Workforce Data Book published by the Centers for Workforce Studies reported that female physicians worked seven hours less a week and treated 30% fewer patients on average than their male counterparts.2
“I would flip the question on its head and say, we do need to provide care to the most numbers [of patients], but we also want to provide quality care,” Dr. Bass says. “The question is: Is it better to see patients every 10 or 15 minutes, or is it better to talk to them a little bit longer and see fewer patients per hour? I think a lot of women would argue that quality of care is more important, especially in fields in which you’re managing patients over the long haul.”
Dr. Bass says more female doctors, as well as younger doctors, expect a better work–life balance when entering the field, which is a major reason why the 2015 Workforce Study projects lower clinical full-time equivalents (FTEs) over the coming years. The field needs to examine a holistic approach to compensation moving forward, she adds. That approach would include paying for services that don’t directly generate revenue, as well as tying in quality and safety measures.
“Reimbursement strictly on an RVU basis, especially in academic centers, doesn’t necessarily give credit or value to a lot of other aspects of work physicians do that are valuable to the healthcare system and to patients,” she says. “Spending more time talking to a patient is valuable. Spending more time teaching residents and doing other non-remunerated things is also valuable. And those activities tend not to be valued or paid for in academic centers.”
Dr. Bass adds that, despite gains in gender equality in society as a whole, many male physicians have a support system at home that allows them to work more hours.
“If you have a model based on what men do—[one in which] women typically are responsible for taking care of the kids at home, etc.—if there’s that [established] model, then women will never achieve the kind of productivity targets that are set based on a man’s structured work life,” Dr. Bass says. “So if society decides that [it wants] equity, [it has] to acknowledge that somebody has got to be there picking up the kids and getting home at an earlier hour … A lot of the men who work long hours have a wife who can be at home.”
Richard Quinn is a freelance writer in New Jersey.
- American College of Rheumatology. 2015 Workforce Study of Rheumatologists in the United States. 2015.
- Association of American Medical Colleges. 2015 State Physician Workforce Data Book. 2015.