AMA Takes on Gender Inequity, Including the Wage Gap

The American Medical Association (AMA) has pledged to close the pay gap between male and female physicians and to take steps to advance gender equity in medicine and within the AMA.

The House of Delegates, which is the principal policy-making body of the AMA, adopted multiple resolutions to advocate for pay structures based on objective gender-neutral criteria and to adopt policies to promote transparency in defining those criteria for initial and subsequent physician compensation.

In addition, the House pledged to work with all relevant stakeholders to host future workshops on the role medical societies can play in advancing women in their respective fields.

During the AMA meeting, held June 9 to 13, 2018, in Chicago, IL, the American College of Cardiology, the American College of Gastroenterology, and the AMA’s Young Physicians Section proposed several resolutions to address the wage gap and discrimination female physicians face in the workplace. The AMA combined the resolutions into a series of recommendations and actions they plan to take, including plans to draft a full report on its positions and principles for gender equity that will be presented at the 2019 annual meeting.

Kim Williams, MD (Rush University Medical Center, Chicago), who co-chairs the American College of Cardiology’s Task Force on Diversity and Inclusion with Pamela Douglas, MD (Duke University Medical Center, Durham, NC), reminded TCTMD that roughly 50% of internal medicine residents are women but that females remain a minority in cardiology departments across the United States.

In one recent survey of 198 residency programs, for example, it was found that women were more likely than men to have never considered going into cardiology and were less likely to have chosen cardiology already.  

“And the question is why?” said Williams. “Part of it has to do with culture, some of it has to with perception. We’re not comfortable attributing it to the heavy call schedule because women go frequently into general surgery and go into OB/GYN, which is the most unpredictable call schedule,” he told TCTMD. “So it really can’t be that they don’t want to be aggressive interventionalists because that’s what surgeons are by definition.”

Instead, Williams highlighted research conducted by Douglas and colleagues in 2016 showing that male cardiologists made $31,000 more than their female counterparts, which is one possible reason women may be less inclined to enter the specialty. Several other studies have confirmed the pay gap, including one analysis showing that women will earn $2.5 million less than a man over a 35-year career.

“That pay gap is pervasive,” said Williams. “It doesn’t occur at Rush where I’m chief and determine the salaries but it appears in a lot of other places. So we’ve taken it upon ourselves to try to right this. It’s not just cardiology, although it’s just a little worse in cardiology than in some other specialties. In medicine overall, there’s about a $20,000 gap between men and women physicians. It’s been an issue for a long time and it exists in many industries, not just medicine or cardiology. We would like to see more equity with pay and for everything to be fair. One of the ways to do that is to call attention to it.”

‘They’re Doing the Exact Same Thing’

Anne Curtis, MD (Jacobs School of Medicine and Biomedical Sciences at University of Buffalo, NY), who wrote an editorial last month pointing out that just 21% of general cardiology trainees are women, spoke with TCTMD this week as the AMA meeting was winding up. She agreed that the first step to fixing the pay gap was to shine a light on the problem. “If you don’t bring awareness to it, things stay the way there are,” she said.  

Likewise, Rashmee Shah, MD (University of Utah School of Medicine, Salt Lake City), the lead author of the analysis highlighting the large difference in lifetime earnings between men and women, said the “big first step” in ensuring pay equity is transparency, which is emphasized in the adopted AMA resolutions.

“It’s basically impossible for anyone to say they’re paid unfairly without having some way to prove it,” she told TCTMD. “On the converse side, it’s hard for the employer to say, ‘I’m paying you fairly,’ without being able to prove it either. There is a need for transparent systems of counting people’s value and the method they are reimbursed for that value.”

Each year, the American Association of Medical Colleges publishes a comprehensive report on faculty salaries for different medical specialties. Curtis said that when comparing men’s and women’s salaries, it’s important to compare individuals within the same specialty because the relative value units (RVUs) generated by some physicians, such as electrophysiologists and interventional cardiologists, are higher than those generated by noninvasive cardiologists. And women, she noted, are much less represented in invasive specialties.

“But then, if you drill down and are looking at noninvasive cardiologists who are men versus women, and there’s a salary discrepancy there, you can’t blame it on the field,” she said. “They’re doing the exact same thing.”

To TCTMD, Shah said the difference in pay between men and women is problematic not only for financial reasons. It points to discrimination and how well women may be received by their employers and supervisors. That reception, she said, plays a role when making career decisions such as choosing an area of medicine in which to specialize. She added that if a female physician is producing less RVUs than a man in the same field, the challenge is to understand why. The lower output might be the result of inadequate sponsorship or mentoring, a structural barrier that is difficult to measure and fix.  

Roxana Mehran, MD (Icahn School of Medicine at Mount Sinai, New York, NY), called the AMA resolutions “historic” and praised the organizations for bringing the issue to the forefront. And while she is pleased that compensation will be awarded in a gender-neutral manner, the “devil is in the details,” Mehran said, particularly if conventional metrics of productivity fail to account for women’s lives.

“For example, how do we account for a woman who might be in her childbearing years and unable to perform some of those requirements?” said Mehran. “More commonly, we would be out of work for a certain period of time and that needs to be stipulated. It can look as if there is gender equality, but in actuality it remains problematic if you go into the details of pay structures, particularly if they are RVU-based.”   

Address the Pay Gap and Discrimination       

When it comes to gender equity in compensation and professional advancement, the AMA acknowledged the data showing significant differences in salary between men and women and the “persistence of implicit bias that disadvantages women in male-dominated professions.”

Along with equal compensation, Williams said it’s important to eliminate bias and discrimination so that women can thrive in the discipline. To achieve this goal, mentoring is critical. “If you have the older, male cardiologists saying cardiology isn’t a good fit for women, and women saying they don’t feel mentored, they’re essentially saying the same thing,” said Williams. “There’s a lot of programmatic, cultural changes that need to happen. Hopefully we will have an impact.”  

For Curtis, not having the right mentors and the negative perceptions about cardiology as a career are two barriers that explain the low numbers of women in the field. Getting around that “has to do with having a positive role model,” she said. “Personally, in my entire career, I’d only train one or two people in [electrophysiology] a year but I’ve had quite a few women. . . . If they see somebody who’s done it, then they say I can do it, too.”

As part of the resolution adopted by the delegates, the AMA also stated they would create an awareness campaign to inform doctors about their rights under the Lilly Ledbetter Fair Pay Act and Equal Pay Act and to establish education programs to help men and women negotiate equitable compensation.

The AMA is the largest physician group in the United States and its House of Delegates represents member physicians from more than 170 national medical societies.