The Gender Pay Gap: Insidious in Medicine, Real in Our Society

I am a woman raised by powerful and successful women. My grandmother was an anesthesiologist who governed our family as a matriarchy. I worked my way through college and med school, achieving everything through my own merits and hard work. I never thought this would happen to me. And yet here I was, learning that my male colleague was making $100,000 more than I was a year, for the simple difference of one day of work a week—and his gender.

The Holy Grail: Choosing My Own Schedule

When I was a resident, I never believed in the gender pay gap in medicine. After all, as a resident, everyone is paid equally, regardless of their gender. After finishing my residency, I took a job working 80 hours a week with a newborn and postpartum depression. (See my post When Standard Care Isn't Standard Enough“)

After that demoralizing and exhausting experience I took a new job in Connecticut, which was a lifesaver. The job was per diem; this meant I was able to choose my own hours. I chose to work 3 days a week on a 9-5 schedule, which is pretty much unheard of in medicine, and was ideal with a newborn at home.

The Price of Choice: Lower Pay

However, this job didn’t pay well. I had no vacation and no benefits, since I wasn’t technically working full time.

The next year, I chose to increase my hours to four days a week, with a 7-5 schedule. I also took two full call responsibilities. My work partner at the time was three times my senior and had acted as my senior resident when I was an intern. We had a great working relationship and ran the clinic together. I took on the role of medical director of the clinic, and he was mentoring me.

Renegotiating My Salary and the Shock of Sexism

I realized I needed to renegotiate my salary and he offered to help me. We decided to ask for salary increases together. We were in negotiations with the administration, and at one point, they accidentally let slip the pay differences between our positions.

They were about to pay him $100,000 more per year, for one more day of work a week.

Percentage Increases and Harsh Revelations

Logically, I should’ve been making 80% of that, since I was working just as hard as him but 4 days a week. We were both appalled and immediately set to work to adjust my salary, working with HR. As the process continued, I prepared myself well and had plenty of meetings with HR. I knew what salary I was asking for, I was just trying to get to the baseline pay.

I had HR benchmark my pay, which they did. They told me they were open to increasing my pay to at least meet the point where it was some percentage of the benchmark. However, when I finally had that conversation, HR said, “We can increase you to this amount.” The amount they proposed was still below the benchmark.

They showed me a proposed increase of 25% above the base salary that I had initially accepted. They explained that this increase was the highest they could go, because 25% was the cap for salary increases.

The Failure of our System: Really My Fault?

Being a high-achieving woman, raised to believe I can achieve anything I set my mind to, and running on a combination of sheer determination and serious self-discipline, read that 25% increase as “my fault.”

Why? Because “I should’ve known better.” I should’ve known better, as a doctor at the beginning of her profession. I should’ve known better, taking a job that was a lifeline for me out of exhaustion. I should’ve known better, having been trained in a medical system that to this point had been equitable. I should’ve known better, because the first time I got paid, I accepted that paycheck at face value, and did not negotiate a higher salary.

Now, I felt trapped down here at this pay rate, so much less than what my male counterparts were making, and believed that I would stay trapped here for the rest of my career. This number, not enough for my family, not reflective of my work and effort and ability, would be the basis for my paychecks going forward. But why should I read the failure of our sexist system as my own failure?

Who Has the Power?

This is the ugly truth of the gender pay gap in medicine. Had I stayed at that job, the administration would have stuck to that salary, because “I should’ve negotiated better initially.” I’m sure they loved that I accepted their initial salary offer and DIDN’T negotiate something better. As far as they were concerned, that was my salary, and there was nothing I could do to appeal it, other than to leave.

In retrospect, I don’t know how realistic that problem was. Were the administrators there just pulling my leg? Did they really have the power to change that situation? Either way, I was so hurt and incredulous that this had happened to me. This was the first time in my life where I had climbed to success through my hard work but felt betrayed by what was actually at the top of that mountain.

The Price of Being a Woman

I felt punished for choosing the schedule that worked best for me and my family. My husband at the time and I were both practicing physicians, him as a surgery resident, which carries its own difficult schedule. But one of us had to be available to our child, so guess who that fell to?

The gender pay gap is not unique to medicine, of course; it’s endemic in America. But I still find it incredible that in a country where women and men endure the same rigors of medical school, internships, and residency, women can be penalized for the mere fact of their sex, let alone their decision to work while carrying and caring for a family. We’ve come so far in terms of rectifying gender gaps in the workplace, but in medicine at least, the salary gap persists, to the detriment of all female physicians’ families.

What gender differences have you noticed in your own field? What’s the best way to shed light on this practice, to help eliminate the gaps for good?