The Patriarchal Pay Gap: How real is it?
Feb 28, 2023
Is it surprising that women working in healthcare earn, on average, 24% less than their male peers and face a larger gender pay gap than in other economic sectors? Not so, per a joint report by the International Labour Organization and the World Health Organization.1
In medicine, even though nationally agreed salary scales should eliminate the effects of individuals negotiating their pay, the gender pay gap is wider than in other professions and employment sectors.
The intensity of inequality
In the groundbreaking report, "The gender pay gap in the health and care sector: A global analysis in the time of COVID-19," gender pay gaps were analyzed in the healthcare sector, and it was observed that despite being heavily feminized, the healthcare sector still suffers from gender inequalities in terms of compensation. The study draws on data from 54 countries, covering about 40% of the sector's workforce globally. The results show that the gender pay gap in the healthcare sector varies between 15% and 24%, depending on the measure used.2
The disparity in pay between male and female physicians has grown in the past five years, despite controlling for factors such as speciality, location, and experience. In 2021, the pay gap between genders was 28.2%, equating to a difference of more than $122,000 in annual compensation. An examination of our data on physician pay from 2014 to 2019 suggests that male physicians earn more than $2 million throughout their careers than their female counterparts.3
Fig 1: Physicians' Average Annual Compensation from the year 2017 to 20213
Fig 2: Medical Specialities with the largest and the smallest pay gaps between men and women in 20213
A closer look at the causes3
Women in medicine face discrimination due to historical exclusion, institutional sexism in medical schools, healthcare organizations, and the fee system. They are often directed towards lower-paying specialities through the "hidden curriculum," and have limited opportunities for leadership roles due to biases in hiring and recruiting. Men tend to dominate higher-paying jobs, resulting in wider gender pay gaps in those categories, while women are overrepresented in lower-paying jobs. Additionally, female general practitioners make 35% less than their male counterparts due to biases in clinical care systems. Mothers in the healthcare sector are disadvantaged, with employment and gender pay gaps increasing significantly during their reproductive years and persisting throughout their careers.
Although sharing family responsibilities more equitably may lead to women making different job choices, factors such as age, education, working hours, and sector participation only partially explain the gender pay gap in this sector.
COVID-19: Widening the chasm
The COVID-19 crisis has disproportionately affected workers at the low end of the pay scale, most of whom are women. The average hourly wage or the monthly income of workers who remain in the sector artificially appears to have increased, although the real total wage bill in the sector has fallen. Controlling for composition effects in terms of the characteristics of healthcare workers before and after the onset of the pandemic, the gender pay gap in the sector appears to have declined only slightly between January 2019 and December 2020.
Fig. 3.1-3.3 illustrate the changes in wage employment in the healthcare sector of Canada, the United States, and Mexico from January 2019 to December 2020. The data compare men's and women's employment in the healthcare sector with that of other economic sectors. The estimates are based on wage employees who claim to be temporarily absent but still receive payment. The figures show that the health crisis caused a sharp decline in employment growth for men and women in all three countries. In Canada and the United States, women were more affected by the decline than men, while in Mexico, men were more affected. The decrease in employment growth was more remarkable in other economic sectors than in the healthcare sector. The data do not include individuals who are temporarily absent from work and not receiving wages.
Fig. 3.1: Employment growth in the healthcare sector, compared with other economic sectors, January 2019 to December 2020: Canada
Fig. 3.2: Employment growth in the healthcare sector, compared with other economic sectors, January 2019 to December 2020: Mexico
Fig. 3.3: Employment growth in the healthcare sector, compared with other economic sectors, January 2019 to December 2020: U.S.A.
Building a bridge
To bridge this gender pay gap, it is crucial to develop strategies to enhance the healthcare sector's resilience. Sector-specific wage data should be collected and analyzed with sufficient frequency to monitor the gender pay gap in the sector.
Investing in decent healthcare jobs, including formalizing informal jobs, would help make the sector more resilient.
To tackle the vital gap, gender segregation in employment in the healthcare sector should be reduced by attracting more men into middle-level occupational categories, providing training and equal opportunities for upward mobility for women healthcare workers, and raising awareness of STEM careers among young girls and women.
Standardizing working conditions between women and men, promoting collective pay agreements, and instituting pay transparency and legal instruments to fight against pay discrimination would help reduce the gender pay gap in the sector.
The gender-based pay gap is an ongoing medical crisis that must be addressed. From a practice perspective, women physicians may benefit from greater organizational awareness of potential workplace bias aimed at better equalizing compensation through more significant support and transparency.
Closing the gender pay gap, promoting decent work opportunities and conditions, and achieving gender parity in the healthcare sector is essential for ensuring that healthcare systems remain resilient against future challenges, including pandemics like COVID-19.
- Women in the health and care sector earn 24 percent less than men. Available at: https://www.who.int/news/item/13-07-2022-women-in-the-health-and-care-sector-earn-24-percent-less-than-men (Accessed on: Feb 22, 2023)
- World Health Organization. The gender pay gap in the health and care sector: a global analysis during COVID-19. World Health Organization; 2022 Jul 13.
- 2021 Physician Compensation Report, Fifth Annual Study. Available at: https://c8y.doxcdn.com/image/upload/v1/Press%20Blog/Research%20Reports/Doximity-Compensation-Report-2021.pdf (Accessed on: Feb 22, 2023)
- Hoff T. The gender pay gap in medicine: a systematic review. Health Care Management Review. 2021 Jul 1;46(3):E37-49.
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