By Lucy Berrington, MS, and Jillian Pedrotty, MHA
The American Medical Association has made a far-reaching commitment to advancing gender pay equity in medicine, in an advocacy effort spearheaded by two Massachusetts physicians.
The AMA delegates overwhelmingly voted to support a broad resolution — “Advancing Gender Equity in Medicine” — at the AMA Annual Meeting in June. The final resolution amalgamated four others, two of them brought by MMS members Julie K. Silver, MD, and Michael S. Sinha, MD, JD, MPH. “Our goal was simple: get the largest medical society in the United States to lead the way in adopting a set of highly proactive gender equity initiatives,” Drs. Silver and Sinha wrote in a piece published by Doximity.
Gender Pay Gap Widening
In recent years the wide gap between men and women physicians’ compensation has generated startling survey findings and headlines. On average, female physicians with equivalent training to their male counterparts earn 28 percent less (about $105,000 less) a year, according to the Doximity 2018 Physician Compensation Report. The gap has widened since 2016 when Doximity reported a 26.5 percent, or $91,284, difference in pay between male and female physicians.
“Even when other factors are held constant, women are still being paid less,” says Dr. Sinha, a research fellow at Harvard Medical School. “You’re being paid less over the course of your entire career, and that’s often based on the first salary you’re offered out of residency or fellowship. It takes a conscious focus on equal pay for institutions to remedy those disparities.”
The AMA initiative drew on Dr. Silver’s ongoing work with medical societies as physicians’ allies in the effort to establish equitable workplaces. Dr. Silver, associate professor and associate chair in the Department of Physical Medicine and Rehabilitation at Harvard Medical School, told Vital Signs, “Our thought was that many other medical societies would follow.”
“If it’s always a minority group talking about how to advance their own cause, it becomes somewhat of an echo chamber, and it’s easy to dismiss the group as complaining. If you have an outsider saying, ‘There’s a problem here,’ that individual is more likely to be heard and taken seriously. In the #HeForShe community in medicine, male physicians are saying, ‘Listen, our female colleagues deserve better.’ It’s a chance for men to leverage their social status in the workplace to bring these important issues to light.”
— Michael S. Sinha, MD, JD, MPH, research fellow, Harvard Medical School
Breakthrough Resolution
The resolution commits the AMA to developing a report with recommendations on promoting gender equity in medicine, and to advocating for institutional, departmental, and practice policies that support pay equity. The delegates pledged to recommend immediate actions, including not asking for job applicants’ prior salary information, creating an awareness campaign to inform physicians about their legal rights, and hosting workshops on the role of medical societies in advancing women in medicine. The AMA also committed to evaluating its own inclusion of women members and supporting gender equity and equal pay within the organization. The final resolution incorporated elements of two other gender equity resolutions, drafted by Hena Patel, MD, a cardiology fellow, and Suriya Sastri, MD, a gastroenterologist, who both practice in Chicago.
Institutional Accountability
The AMA resolution implicitly recognizes that pay gaps reflect structural and systemic biases and calls for structural and systemic solutions, as opposed to relying on individuals to improve their salary negotiating skills. “If people from underrepresented groups (for example, women or ethnic minorities) get paid less, that’s a really big ethical and legal concern for leaders and institutions,” says Dr. Silver. “My work is about having change come from the leadership, from the people who have the most power and financial resources to drive change, as opposed to individuals who are discriminated against, which is not a reasonable approach. But at the same time, you can’t count on institutions to right-size and equilibrate, so trying to educate people about this is also important.”
Young Physician Leadership
The AMA House of Delegates’ support for the combined resolution followed the unanimous approval of the Young Physicians Section of the two resolutions developed by Drs. Silver and Sinha. “It was really important for the AMA to hear from the next generation that this is what they want,” says Dr. Silver. “In this next generation, the majority of doctors come from one or more underrepresented groups. Early career physicians have been exposed to social justice issues in ways that physicians who were trained at an earlier time were not. They want everyone to be successful, to have a level playing field.”
That profile of young physicians dedicated to social justice issues and identifying as leaders was described in the 2015 Trends Identification Report of the Annual Association of Medical Society Executives: “Early career physicians are seeking to build trust with their medical societies on many levels. They want to have a hand in shaping the future of their organizations, co-creating products and services, and have increased desire for their organizations to be transparent, ethical, and socially conscious.”
The rise of dual-physician households is also contributing to increased awareness, says Dr. Sinha. “A lot of male physicians are married to female physicians and so they suddenly have their own personal and financial stake in some of these issues.”
Advocating for Equitable Policies
The resolution refers to several institutional, departmental, and practice policies that support pay equity. These include transparency around criteria for compensation; pay structures based on gender-neutral, objective criteria; improved oversight of compensation models and metrics; and training to mitigate implicit bias “with a focus on how subtle differences in the further evaluation of physicians of different genders may impede compensation and career advancement.”
