Cardiology’s Wage Gap: Time to ‘Own the Problem and Fix It,’ Experts Say

Another study, this one looking at physician salaries at public medical schools in the United States, has confirmed the significant wage gap between men and women across medical specialties, including cardiology.  

Strikingly, the amount of money at stake echoes that of an earlier analysis of cardiologists in clinical practice that made waves in 2015.

The latest study, which looked at academic physicians at 24 public medical schools in 12 states, found a wage gap for every medical specialty examined (with the exception of radiology). However, the degree of difference varied, not only by medical specialty but also according to faculty rank and between institutions.

“Among academic physicians in 24 US public medical schools, annual salaries of female physicians were substantially lower than those of male physicians after adjustment for a rich set of factors that influence salary,” Anupam B Jena, MD, and colleagues write. “Nearly 40% of the unadjusted difference in mean salaries between men and women remained unexplained.”

Their findings were published this week in JAMA Internal Medicine.

Minding the Gap

A total of 10,241 physicians were included the study, 3,549 of whom were women. Cardiologists made up just 3.6% of the cohort—369, of whom 75 were women.

After adjusting for a range of factors, including faculty rank, research funding, clinical trial participation, and years of experience, study authors report that female cardiologists earned $229,940 a year while male cardiologists made, on average, $263,690. These figures are substantially lower than salaries for cardiologists in clinical practice revealed in a study by Jagsi and colleagues at last year’s American Heart Association Scientific Sessions, as reported by TCTMD, which drew on a practice administrator’s database that listed 2013 salaries for 2,679 cardiologists in 161 practices. In Jagsi et al’s data, the median annual salary for male cardiologists was $502,251 and $394,586 for women. Notably, however, the dollar amount for the wage gap reported—$37,000 after adjustment for confounders in last year’s study—was nearly identical to the figure of just under $34,000 reported in the current study.

Speaking with TCTMD, senior author on the earlier study, which was subsequently published in the Journal of the American College of Cardiology, Pamela Douglas, MD (Duke Clinical Research Institute, Durham, NC), called the similarity “remarkable” and “almost uncanny.”

In Jena et al’s study the wage difference between male and female cardiologists was among the larger amounts documented—similar to the gaps seen in the specialties of hematology/oncology (38,000), obstetrics/gynecology ($36,000), and surgery ($32,000), although lower than those seen for orthopedic surgery ($41,000) and surgery subspecialty ($44,000) and greater than differences in 11 other medical specialties.

That’s important, Douglas observed, since it speaks to a larger problem in the resource-based relative value scale (RB-RVS) used for physician reimbursement, in which procedure-based specialties are valued more highly than cognitive-based specialties. Jena et al’s data point to the fact that it is also the procedure-based specialties that see the larger wage gaps. Douglas noted. Indeed, their earlier analysis indicated that women in cardiology were much less likely to do procedures/interventions and were more likely to do cognitive work: patient consultation, stress testing, echocardiography, etc, which are considered lower-value services.

Differences by Institution, Rank

Salary differences in Jena et al’s study were seen across all faculty ranks, but they were largest for full professors. Female full professors, after adjustment, tended to make salaries equivalent to male associate professors, while salaries for female associate professors were roughly on par with those of male assistant professors.

Also worth noting, not all of the public medical schools studied appear to be paying their male and female physicians differently. Adjusted salaries were significantly higher for men at nine of 24 schools and point estimates were higher at 17 schools. At seven schools, however, adjusted salaries were the same or higher for women, with two schools having significantly higher salaries for women than men.

“Obviously some institutions can figure this out,” Douglas commented. “There are established HR strategies for insuring salary equity across diverse groups including for slightly different job descriptions, and academic institutions, particularly publicly funded academic institutions that have a responsibility for being nondiscriminatory and have a commitment to diversity, should take this need to heart.”

How to Fix the Problem

An accompanying editorial by Vineet M Arora, MD (University of Chicago, IL), cites “a bevy of literature” supporting the possibility that women are not doing as good a job as men at negotiating higher salaries and that this represents one area in which skill-building may help women get better pay. Douglas, for her part, dismisses a theory that shifts the problem back onto women or suggests that the onus is on them to do things differently.

“I think our institutions and our profession more broadly need to commit to diversity, and by that we need to make sure we have a level playing field for all of our participants. Choosing to enhance the skills of some of the participants does not replace the [necessity] of having a level playing field,” she said.

Both Douglas and Arora point out that the wage gap is indisputable: efforts now should move from studies continuing to document its existence and instead should focus on solutions.

“I think now we have the data to know that we have a problem. What we really need here are solutions to get us to the point where cardiology is a fair and welcoming profession for all of those who chose to pursue it,” Douglas told TCTMD.

Indeed, Douglas points to a “Leadership Page” by Kim Allan Williams, MD, and Richard A Chazal, MD, now past-president and president, respectively, of the American College of Cardiology, which was published when the paper by her and her colleagues appeared in print. The College, according to Williams and Chazal, needs to accept that there is a problem in the profession that will have an adverse effect on patient care: “Let’s own it and fix it,” they write.

Jena and colleagues point out that they would not even have been able to conduct their analysis if it weren’t for Freedom of Information laws mandating the release of government financial records, including the salaries of employees of public universities. “Our use of publicly available state employee salary data highlights the importance of physician salary transparency to efforts to reduce the male-female earnings gap,” they conclude.