The answer is a resounding no. In 2017, the American College of Physicians asked some of its members, “What is your estimated annual income from your professional activities before taxes?” Of the 374 full-time internists who responded to the survey, the median salary for men was $50,000 higher than the median salary for women. In other words, women who are internists earn 80 cents for every dollar earned by men, even when one takes into account professional and employment characteristics.10
Why is this the case? The American College of Physicians released a position paper in 2018 outlining some possible explanations, including the following:11
- Limited opportunities for advancement: Women comprise half of all medical students, but their numbers dwindle in the higher levels of academia. Women constitute 38% of full-time medical school faculty, but only 21% of full professors, 15% of department chairs and 16% of deans. Lack of appropriate mentorship and lower rates of advancement may contribute to this.
- Workplace discrimination: Women who are physicians are five times more likely to experience obstacles to career advancement, and three times more likely to experience disrespectful or punitive actions, than their male counterparts.
- Implicit bias: Female physicians are scrutinized more critically than male physicians. Female physicians may be described as judgmental, rude and unfriendly for exhibiting the same personality characteristics seen as positive among their male counterparts.
Of these, implicit bias is the most insidious; because it is subconscious, it is difficult to address. One interesting example: At the University of Pennsylvania, 24% of the clinical faculty in 1996 were women; by 2007, the female clinical faculty had increased to 30%. During this time, however, only 10% of clinical award recipients were women. The authors of this study suggested that one possible explanation for the discrepancy might be our implicit biases in how we judge female vs. male physicians.12
Our patients may be suffering as a result. In the Medscape survey, if they had to do it all over again, 78% of female rheumatologists say they would train in internal medicine, but only 48% would have chosen again to train in rheumatology. This is bad. If around one-third of practicing female rheumatologists are telling us that knowing what they know now they would not have chosen to specialize in rheumatology, then our workforce issues are even more dire than we had suspected.
Our patients may suffer in less obvious ways, as well. In a study of more than 1.5 million Medicare hospitalizations, patients treated by female physicians had a lower 30-day mortality and a lower 30-day readmission rate. In this study, the number needed to treat was 233, meaning that if 233 of these patients had been treated by women rather than men, one additional life would have been saved.13
