Women in medicine make up 50% of undergraduates and women hold well over 30% of all medical jobs. Until recently, the fact that women in medicine earn much less than men was attributed to the fact that women are more likely to choose lower-paid work, work fewer hours, and to choose part-time work, as well as choosing lower-paid specialties like psychiatry, public health and general practice. But recent research published in the JAMA has revealed that women in medicine earn significantly less than men, even when these “lifestyle” choices have been adjusted for. The authors compared male with female earnings over time (20 years) and, in a substantial and powerful sample size (over 6,000 physicians and over 31,000 allied health professionals), found that male doctors earn up to 25% more than female doctors. The researchers analysed three periods of time (the late 1980s, late 1990s and late 2000s) and found that during each period the proportion of women in medicine increased over time, but there was no significant improvement in women’s earnings in relation to men’s earnings, over time.  

According to the Medscape Physician Compensation Report of 2012, male doctors now earn up to 40% more than female doctors, and in the area of primary care males earn 23% more than females. This is pretty sad news given that most GP graduates, especially those in primary care, are women. It means that for as long as medicine continues to be feminised, it will also become impoverished. The fact of the matter is that women are valued less by society at all levels, and that professional status is no protection of earning power for women. 

Having spent a good many years working in two female-dominated specialties as well as more mixed fields (and I currently work in a rather testosterone-rich speciality), I do notice that here is a tendency among female doctors to shun the idea of demanding more money for work. Women in medicine are expected to be self-sacrificing. They tend to feel embarrassed about wanting to be paid well: and yet, at the same time, women who are being underpaid and undervalued in medicine are deeply frustrated, often bitterly so. On the other hand, women who are upfront about money and are unashamed to express their desire for high salaries tend to be a source of some criticism in medicine. Such women are viewed as brash, shrill and difficult. 

Women doctors who are active in representative organisations have traditionally advocated for “softer” values, such as patient care, professional status and better working conditions. But women in business have long realised that when it comes to power, esteem and professional status, it’s all about the money. Leadership is an empty, hollow vessel if you are allowing yourself to be paid less well than your peers.

Women business academics, such as Prof Margaret Neale of Stanford Business School, have developed strategies specifically aimed at women leaders who find negotiating for higher salaries to be difficult or uncomfortable. As a woman, negotiating for a higher salary isn’t something that comes naturally, and others can be shocked or even disgusted by a woman who is honest and upfront about wanting to be paid more. Women are expected to not mind being underpaid, and to want to stand back and allow someone else to take the promotion, or get the pay rise: and in medicine, the current trajectory of de-investing in the public sector and of devaluing general practice is hitting women doctors much harder than men.

Same work, same worth 

Doctors in general are under severe public scrutiny now, as our earning power is questioned ruthlessly by a society that demands that doctors are motivated by vocation and not just by the dollar sign. And these are good demands. In an ideal world, doctors are not motivated by their earning power: they are motivated to heal the sick and to progress science. There is also a powerful trajectory in contemporary political philosophies, which is to question inequality. Recent targeting of public sector pay was based on the notion that, simplistically speaking, no one should earn a lot more than anyone else. 

Inequality is not progressive for any society, and therefore equalisation of opportunity or wealth is an attractive aim. In the case of women in medicine, however, we do need to be careful that the current push to “equalise” pay doesn’t simply push women further and further down the pay scale in relation to men. Yes, doctors should be motivated to heal and to learn rather than simply to be well heeled and to earn. And yes, nobody should be stinking rich while others struggle to stay alive. But equality is about making sure that the same people who do the same work are treated with the same worth. It is simply not acceptable that women earn 40% less than men, in any profession, for doing the same work. 

Now that doctors’ salaries are the subject of a concerted campaign to “equalise” us with those in other professions, the danger is that the inequality between male and female earnings in medicine will become yet another race to the bottom. The bottom line is that unless male doctors want to see their standards eroded even further, women in medicine will just have to start looking for more. And male doctors are just going to have to advocate for them. Ouch.