August 31, 2020
2 min read
Kiran is the Fidani Chair in Improvement and Innovation at the University of Toronto and is supported as a clinician scientist by the department of family and community medicine at the University of Toronto and at St. Michael’s Hospital. She is also supported by Health Quality Ontario and the Canadian Institutes of Health Research as an embedded clinician researcher.
Women in medicine continue to face pay gaps in every specialty and between specialties, according to research published in CMAJ.
“Pay equity is grounded in the basic principle of equal pay for equal work,” Michelle Cohen, MD, an assistant professor in the department of family medicine at Queen’s University in Kingston, Ontario, told Healio Primary Care. “However, a growing body of research shows that women in medicine are consistently paid less than men for a variety of reasons. Addressing this inequity is necessary for the medical profession to move from aspirations of gender inclusion to equity and justice for women.”
Cohen and Tara Kiran, MD, MSc, an assistant professor in the department of family and community medicine at the University of Toronto, conducted a data analysis to assess average gross payments by specialty in Canada and the estimated net income of physicians by specialty.
The research follows a report from the Ontario Medical Association published in July that found a 15.6% pay gap between men and women physicians. The report found that the largest pay gap, 19%, was in family medicine, while the smallest gap was 10.2% in surgical specialties.
Cohen and Kiran found that among the 10 specialties with the highest gross and net incomes, women accounted for fewer than 35% of physicians. However, they found that women accounted for 47% of physicians in family medicine, 48% of those in psychiatry, and 62% of those in pediatrics — the specialties with the lowest net income.
They added that a recent analysis found that compared with their female colleagues, male family physicians earned 30% more and male specialists earned 40%, and men earned more within their respective specialties.
Cohen and Kiran wrote that because compensation is Canada uses a fee-for-service model, women’s lower income could be due to working less. The Canadian Medical Association’s 2019 National Physician Survey revealed that women worked 4.7% fewer hours per week and had 8.6% fewer on-call hours compared with men; however, this difference is smaller than the income disparity between men and women physicians, according to Cohen and Kiran.
They added that a 2017 study of PCPs in British Columbia showed that women made 36% less than men despite having just a 3.2-hour difference in patient care workload each week.
While data suggests having a child temporarily decreases work hours, Cohen and Kiran said, women do not work substantially less than men throughout their careers.
In terms of the causes of gender pay gaps, Cohen said that “women in medicine face discrimination throughout their careers.”
She said the discrimination women face “is rooted in the history of women’s exclusion from the profession, along with the institutional legacies of sexism in medical schools, clinical care arrangements, health care organizations and the fee system itself.”
Some factors that contribute to pay gaps include hidden curriculum, referral bias, sexist discrimination during hiring and promotion practices, and lack of female leadership, particularly in committees negotiating physician payment with the Canadian government, Cohen said.
Addressing physician gender pay gaps will require a multipronged approach, she added.
“Medical associations must commit to closing the pay gap and must work with governments to do so, particularly in the Canadian system where the government acts as the primary payer of medical services,” she said. “Transparency around physician payments is essential and should be undertaken by both governments and health care institutions.”
Cohen said that “more work needs to be done at all levels to promote women into leadership roles where they can have a larger say on issues impacting women in medicine.”
Cohen M, Kiran T. CMAJ. 2020;doi:10.1503/cmaj.200375.
Ontario Medical Association. Report to Council: Understanding Gender Pay Gaps Among Ontario Physicians. https://content.oma.org/wp-content/uploads/private/gender-pay-gap-report-august-2020.pdf. Accessed August 27, 2020.