Gender Inequality In Medicine: Where Do We Go From Here?

A recent report in the New England Journal of Medicine examining the gender gap in physician pay found that in 2017, female primary care physicians (PCPs) generated nearly 11 percent less revenue from office visits in comparison to their male counterparts.¹ In fact, female PCPs conducted 10.8 percent fewer visits over 2.6 percent fewer clinical days but spent 2.6 percent more time in visits than males. 

For this study, based on national all-payer claims and data from electronic health records, the authors conducted a cross-sectional analysis of 24.4 million primary care office visits in 2017 in their comparison of female and male physicians in the same practices.¹ They concluded that differences in time spent with patients is an important contributor to the gender pay gap in medicine with females generating 87 percent of what male physicians generate per hour of direct patient care.  

Of course, the issue is not exclusive to primary care and has far greater implications for health care in general. Indeed, several studies over the past few years suggest that female physicians have better patient outcomes than males when it comes to mortality and readmission rates in hospitalized patients, surgical complications and diabetes care.^2-4 Yet, despite the apparent high quality of patient care, female physicians face a greater risk of burnout than males.⁵ 

There is certainly a gender gap in podiatric medicine and surgery, one that goes well beyond pay.  

Brower and colleagues reported that despite a steady increase in the number of women entering podiatric medicine and surgery, there continues to be a large gap in terms of leadership and academic positions held between men and women in the field.⁶ Using a combination of national and state data compiled from various podiatric organizations as well as a secondary questionnaire, the authors noted that “female podiatric physicians were more likely to be single, have fewer children, spend more time in a clinical setting, be less satisfied with work, and experience higher work stress levels than their male colleagues.”⁶

Remarkably (and equally disturbingly), 73 percent of females described experiencing gender discrimination at some point in their career and 42 percent reported experiencing sexual harassment.⁶

As a profession and, frankly, as a society, we must do better. Being the proud husband of an extremely talented female in health care and a “girl dad,” I am hopeful that with more education, research and awareness of the issue, meaningful change is possible. Females deserve just as much consideration for academic and leadership positions as males in podiatric medicine and surgery. As the Journal of Foot and Ankle Surgery article suggests, scientific and professional societies should play a critical role in developing and enforcing guidelines focused on gender equality.⁶

In addition, according to the aforementioned NEJM article, it may be necessary to reassess the productivity-based payment model that contributes to the gender pay gap and focus on ways to optimize the amount of time physicians spend with patients without sacrificing outcomes.1 The road to gender equality in medicine will be complicated and fraught with challenges at so many levels, but when we consider the alternative, inaction is unacceptable.

Dr. Isaac is the Director of Research with Foot & Ankle Specialists of the Mid-Atlantic (FASMA). He is a Diplomate of the American Board of Foot and Ankle Surgery.

References

1. Ganguli I, Sheridan B, Gray J, Chernew M, Rosenthal MB, Neprash H. Physician work hours and the gender pay gap - evidence from primary care. N Engl J Med. 2020;383(14):1349-1357.

2. Tsugawa Y, Jena AB, Figueroa JF, Orav EJ, Blumenthal DM, Jha AK. Comparison of hospital mortality and readmission rates for medicare patients treated by male vs female physicians. JAMA Intern Med. 2017;177(2):206-213. 

3. Wallis CJ, Ravi B, Coburn N, Nam RK, Detsky AS, Satkunasivam R. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study. BMJ. 2017;359:j4366.

4. Berthold HK, Gouni-Berthold I, Bestehorn KP, Böhm M, Krone W. Physician gender is associated with the quality of type 2 diabetes care. J Intern Med. 2008;264(4):340-350.

5. Linzer M, Harwood E. Gendered expectations: do they contribute to high burnout among female physicians? J Gen Intern Med. 2018;33(6):963-965. 

6. Brower BA, Butterworth ML, Crawford ME, et al. The podiatric medical profession: a gender comparison. J Foot Ankle Surg. 2020;59(5):997-1007.