Women and Black Doctors Still Make Far Less Than White Male Doctors

A new report finds that when it comes to physician pay, women and black doctors still make less on average than their white male counterparts. Unfortunately, that gap is nothing new, and suggests a systemic bias similar to that found in other professions. Experts say that’s not just a problem of people getting equal pay for equal work. It can also influence who enters the profession and even, some research shows, affect patient care.

The numbers are according to the Medscape 2018 Annual Physician Compensation Report, a survey of 20,000 US physicians across 29 specialties. It found that the country’s doctors are well compensated, making $299,999 on average, up from $294,000 in 2017. Specialists, unsurprisingly, make more than primary care physicians ($329,000 versus $223,000), while plastic surgeons overtook orthopedists this year as the highest-paid doctors—thanks perhaps to more candor among celebrities who’ve reduced the stigma around having work done, and an aging Baby Boomer population willing to undergo it.

But compensation gaps persist among women and black doctors. Among primary care doctors, men made an average of $239,000 versus $203,000 for women, a difference of almost 18 percent. Among specialists, the gap was even wider, with men averaging $358,000 to $263,000 for women. The disparity is similar to last year’s numbers, and it hasn’t improved for black doctors, either. They earn an average of $50,000 less than white doctors ($308,000 for white doctors versus $258,000 for black doctors). Black women, meanwhile, earn nearly $100,000 less than male black doctors ($322,000 to $225,000).

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Those are a lot of numbers. Hansa Bhargava, Medscape’s senior medical correspondent, explains what they suggest about how doctors are getting paid. “It’s not just medicine,” she says, “It’s across many professions. And a lot of the same themes carry across all professions.” She points to a lack of transparency around salaries as one example: In most cases, people simply don’t know what their peers are making which puts them at a disadvantage when it comes to negotiating pay. That makes haggling over pay even more difficult for women, Bhargava says, who often feel less comfortable demanding higher salaries.

She notes that the gap is surprising given that med schools are getting closer to parity when it comes to admissions. “We’re pretty much at half and half, as far as male graduates versus female graduates,” she says, “and yet when you look at academia, you see that only 15 percent of deans are women.” Research also tends to be dominated by men, she says; men are more often lead authors when it comes to published research.

The disparity in leadership roles, Bhargava says, ultimately hurts everyone involved. It affects who enters the profession, who feels they have a seat at the table (and who remains), and ultimately affects patients. “When you have diversity at the table,” she says, “whether it’s gender or ethnicity, you get a different point of view, and you get different strengths at the table.”

Anupam Jena is an associate professor of health care policy at Harvard Medical School and a physician at Massachusetts General Hospital. He’s studied racial and gender pay gaps; though he didn’t participate in the Medscape survey, he says it echoes his own research. (He also notes how little attention had previously been paid to racial disparities: Medscape, for one, only started asking the ethnicity of survey takers last year.) When it comes to pay gaps, he says, “the pattern is no different than what we see in the overall economy.”

It’s important to find the why behind that pattern, Jena says, and some of the easy explanations don’t convince him. One possible explanation for a pay gap between black and whites is that they gravitate to different fields. The Medscape survey does show that a higher percentage of black men and women go into general practice versus higher-paying specialties, compared to their male peers. It’s easy to seize on that data point to suggest it explains the pay difference, he says. But that simply displaces the question: Why do a higher percentage of blacks go into general practice? What’s the racial difference apparently affecting those choices?

He’s also skeptical of solutions that put the onus on individuals. Transparency in pay may sound like a good idea, giving physicians more data to support their negotiations. But Jena says the benefits may be largely theoretical; he hasn’t seen research showing transparent salaries actually narrow the pay gap.

“More than transparency,” Jena says, “what you want is some degree of accountability.” It’s not enough to simply publish information about pay disparities—some organization needs to take charge of pushing systemic change. Jena points to a number of medical associations that could take up that role if they chose. Ultimately, we already know disparities exist. Now it’s a question of who’s going to step up to make concerted efforts at closing them. “I think accountability could be very powerful,” he says. “Transparency alone is probably not going to be enough.”

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