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DENIAL of an income gap between male and female health care professionals in Australia is a big part of the problem in achieving equality, says a leading advocate for women’s issues in the medical profession.
Dr Jill Tomlinson, secretary of the Australian Federation of Medical Women, said it was disappointing that women still did not have equal pay for equal work. “People denying that the situation exists does not help solve the problem”, Dr Tomlinson told MJA InSight.
She was responding to US research published in JAMA Internal Medicine which showed the earnings gender gap in health care has actually increased since 1987. (1)
The US study used data from 1987 to 2010 to estimate trends in the male–female earnings gap for physicians, other health care workers and workers overall.
The authors found that the gap for physicians was 20% (US$33 840) in 1987–1990, 16.3% (US$34 620) in 1996–2000, and 25.3% (US$56 019) in 2006–2010. They also found that the gender earnings gap was smaller for nurses and pharmacists, and for workers in non-health-related occupations.
When asked by MJA InSight about income disparity, a spokesman for the Royal Australasian College of Surgeons said the college was “not an employer and we do not have a perspective on this issue”.
The Australian Bureau of Statistics (ABS) 2011 Census shows just 16% of surgeons are female. (2)
A spokesman for the National Association of Specialist Obstetricians and Gynaecologists said he did not believe there was “inequity in pay scales within our profession on the basis of gender alone”.
“Earnings are somewhat different to rates of pay”, he told MJA InSight.
Dr Tomlinson said the assertion that the income gap was attributable solely to female physicians working fewer hours than their male counterparts did not hold water.
“Data that has been adjusted for those factors shows that female doctors still earn less than men”, she said.
“Those who believe that medicine doesn’t [have a gender income gap] need to look at the evidence base.”
Figures from the Medicine in Australia: Balancing Employment and Life (MABEL) study, the national longitudinal survey of doctors run by the Melbourne Institute and Monash University, show that, in general practice at least, Australian women earn an average of 25% less than their male counterparts. (3)
In comparison, average total earnings for women in the general adult working population were 20.7% lower than for men.
Figures supplied to MJA InSight by the Workplace Gender Equality Agency (WGEA) showed that the proportion of men in higher-paid health care jobs is much greater than women.
For example, the WGEA figures show that male anaesthetists make up 69.9% of the specialty and earn 25.03% more than their female colleagues.
A WGEA spokeswoman said that, based on average weekly earnings data compiled by the ABS, the gender pay gap in the health care and social assistance sector in Australia, which also includes nurses, receptionists and aged and disabled carers, was the highest of all industries. At May 2013, the gap was 32.3% compared to 31.3% in May 2012, the spokeswoman said.
AMA president Dr Steve Hambleton said the earnings gender gap between male and female GPs could be accounted for by “patient selection”.
“Patients seeking, for example, pap smears or help with emotional problems, are more likely to self-select female GPs”, Dr Hambleton told MJA InSight. “Women GPs may also see patients for longer, and therefore see fewer patients.”
“[The AMA] is working with specialist colleges to try to improve things for female physicians with more flexible training arrangements, job-sharing and other measures to make it easier for them”, he said.
Dr Tomlinson said full disclosure of salaries would help women to negotiate and advocate for equal pay.
“We do need to ensure that we talk about wages to encourage young women, particularly, to manage their finances and get the appropriate pay for the job they are doing.”
1. JAMA Intern Med 2013; Online 2 September
2. ABS 2011; Data and analysis
3. MABEL 2010; Female GPs earn 25% less than male counterparts
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Like others have already commented, there are many other valid reasons why the average pay is less for females. I doubt seriously that they have to do with gender discrimination per se. Certainly all the way up to pre-consultant levels the wages are set equally.
I agree, and this is on research in different countries. In general Practice female GPs do take longer consultations, deal with more complex issues, have more immigrants and are more prone to deal with mental health problems. As a cosequnce they have more needs for peer support, supervision or Balint groups. If the aim is to earn equal money, for time used, the pay system should be changed, But it is a complex question and the problems mentioned here, may not be the case in hospitals. Surely some private female specialists earn a lot more money.
I agree with Steve Hambleton.
Female doctors are selected by patients wanting longer appointments, which are financially less lucrative than seeing more patients for a short consultation. How often do we see patients, male and female, with a shopping list? The same patients complain about being kept waiting, and expect to ring for results, referrals and prescriptions, without paying… Not only do we earn less per hour seeing these patients, we are stressed by trying to fit all their demands into a standard appointment, and by running late as a result. The worst I have encountered was a family of six in one ten minute appointment, and by the way, could I hurry it up as one child was diabetic and due for dinner at the 6.30 PM appointment., and would I mind doing a referral for the twins who saw the Paediatrician yesterday., and would I treat the family for the flu and vaccinate them all at the same time?
Recognising that women in our profession earn less is a starting point for females who are not manicuring their long nails while drinking a latte or two.
Female doctors need to decide whether we want to demand equal pay for equal work, or whether we want to fool ourselves that we are more liked by those who use us for their financial gain. If we want to be popular and poor, rather than respected and reasonably -remunerated , that is our choice.
I use the analogy of the plumber, electrician, mechanic-one problem, one appointment, and I am booked for the next month.
My experience in private practice is that my female colleagues tend to make choices in practice style that reduce their income earning potential either by increasing their operating costs or by reducing their gross earning potential. Most of us do make some such choices, but it becomes a matter of degree. Decisions about bulk-biling, how much gap to charge, and what type of work to take on, are examples.
Sorry but as one who works purely in the State system where remuneration is according to legal documents agreed between the AMA and government I believe that it should be explained how women manage to find themselves earning less for the same work over the same time.
If I was being paid 25% less I’d have the AMA speak to my employer.
I would venture to suggest that part time work means that it is men and not women who do overtime at 1.5-2 times normal pay and thus hour for hour worked women only appear to be more poorly paid.
For the non mathematicians if I work 20 hours for $1 I earn the equivalent of $40 per 40 hour week. If I work 40+10+10 hours at $1-2 per hour I earn 40+15+20 or $75 over 60 hours or $50 per 40 hour week or 25% more.
Lies, damn lies and statistics?
I work in the same specialty as my husband – GP. I earn less, because ‘female GP consults’ take longer, as Steve Hambleton rightly pointed out. When male colleagues suggest patients come to me for their pap smear, or for a sympathetic ear, it means their day goes faster and mine slower. I then earn less. This work, which is emotionally draining, is not valued in Medicare dollars. It’s as Steve points out – patients select female GPs for a certain type of consult, and we are subsequently disadvantaged in earning potential. While I don’t mind the work, I’d like the work to be valued properly.
This issue made the press when the MABEL findings were published. There are lots of reasons why women and some male doctors take home pay is lower than other doctors, including chosing to work part time and combining general practice with other professional activities such as teaching. My understanding from the article above is that the pay per hour worked is lower for female doctors. I believe this is more a reflection of the current renumeration system in place in private practice, especially general practice, with time based item numbers that financially reward more shorter consultations over fewer longer consultations. Doctors – female and male who choose to spend more time with their patients and in so doing are able to offer a more wholistic and comprehensive approach to health care are disadvantaged financially by the current system, especially if they choose to work in a low socioeconomic area where private billing of all patients is not possible. It is true too that patients self select and will come back to a doctor who they know will listen to them and give time when it is needed.
I read this article with some level of trepidation and growing disappointment. As a female, I have always felt that on a pay level I could state their was no issues in gender bias. Per hour, I am paid at the same rate as my male colleagues. In Public Practice where negotiations are undertaken collectively, this remains consistent. To state that there is discrepancy, seems to be coming from issues is the Private sector where pay scales are anywhere above the Medicare Rebate. This is determined by commercial forces and the individual. How can their be full disclosure when an individual sets what they are prepared to charge? There, I suspect, is one of the main reasons for your discrepancy. Differing hours of work, differing specialties, proceduralists vs non, consultation preferences (long vs short) all play a factor and cannot be controlled by anyone but the individual. If you feel the need for a benchmark then discuss this with your local AMA or ask Federal AMA to look at this from an advocacy perspective. From an IR perspective the base has been set in the Public Arena and my inequality with other colleagues in my Specialty at my place of employment (male & female) stems from my choice to be part-time in a Public Hospital only.
Generalisations of this sort do not assist the argument of gender pay inequality, which is probably a bigger issue in other sectors than ours.
I am surprised that some reaserch has not discovered that women’s nails are consistantly longer than men’s! What I am surprised about is that MJA has turned into a tabloid too instead of trying to be a weighty professional journal. Of course women would earn less. Have you ever heard of any woman working more than few hours per day? Or taking shorter for their caffe lattes? or not taking many months off for getting preganat and thounds of other reasons? I for one am sick and tired of hearing these kind of “researches”. Do or Would I pay a lower percentage of income generated by a woman GP than a man? Resoundingly the answer is No. Do they expect more for the same job? The answer is resoundingly Yes.
This is a complex issue.
There are many reasons why women earn less than men,some of which reflect personal choice.
My husband and I both work in the same specialty. He has almost always earned more than me. This because he has generally worked longer hours, while I have had more domestic responsibility, partly by choice and agreement. He has also chosen to work in more highly remunerated areas, where I have chosen more lowly paid areas like some teaching for example. However, i also think that women don’t value their own work as highly as men and are less inclined to request pay increases (and there is evidence from the wider workforce to back this up) and I agree that women are less good at negotaiting contracts than men. I also wish our specialty had more procedures!
We now can make lifestyle choices in our careers which are often a trade off between hours in paid work and other non paid activities As i age my earnings decrease but my lifestyle improves. Women are much better at choosing to modify the paid hours treadmill whether by family or other pressures. In anaesthesia there are less women prepared to do on-call so they tend to avoid public practice and private practice can require doing the bad (on-call) with the good (private lists). In private practice you charge what you think you are worth and males often are stronger in determining their self worth as they often have the pressure to maximise the basic family income . As women progress along lifes stages i note they are better able to charge what they are really worth and work longer hours if they wish. Perhaps we should ask why do male doctors feel the pressure to earn more and spend less time smelling the roses. With the coming oversupply of medical graduates maybe then we all will be forced to work less onerous hours and conditions and will not worry about the earnings disparity or the ? happiness disparity
Perhaps the real issue is not gender inequality, but that procedural specialties shouldn’t be paid so much more…
I note that there is no breakdown of subspecialty breakdown. I suspect that women tend to work more in non procedural specialties compared to males – it is well known that procedural specialties earn more.
I read this blog recently – it was quite interesting…
http://offthescript.com.au/2013/07/15/its-not-fair-why-are-some-doctors-paid-more-than-others/
Yes, there are valid reasons why women earn less – mainly to do with the way we choose to practice. I am concerned, however, that with an increasing move towards individual contracts for GPs and staff specialists that women may be disadvantaged in negotiations, and not even be aware of it. Full disclosure would help to rectify this.
There are numerous biases pushing total compensation down for female doctors. These include: fewer working hours, working in jobs with lower intensity work/compensation, working in lower compensation specialties, less experience due to time off having children. Most of these are the choice of the individual. Our system is really based on the individuals having choice in their career. For women that want more money, I would urge them to make appropriate choices. In my experience, there is a bias keeping female compensation up, not down.
I absolutely agree that there should be equal pay for equal work irrespective of gender. Are the reported differences in public or private sector? Or is this due to differences in subspecialty selection? Working in the public system, the difference in earnings mainly seems to be a higher proportion of females choosing to work part time for family reasons rather than the difference being due to differing pay rates for the same role.
I think this is all such rubbish!
Find me ONE job ad for a registrar or PHO where there is a differenital offered based on gender -JUST ONE
I am sure the Sex discrimination Ombudsman will be interested.
Find me ONE female surgeon or physician who has been told what fees she may set. JUST ONE.
The ACCC will be interested.
I am a surgeon and practice in a less sexy subspecialty, I choose to have a day off a week and choose to spend longer with my patients.
Surprise surprise I earn less. I neither whinge or am jealous of my colleagues, I pity them.
I suppose I should really be advocating for a Ombudsman for the “Motivationally Challanged”, to fight to get me a pay commensurate with my colleagues who work longer and harder rather than advocate for people to be rational and responsible for thechoices we make, but I reckon I stand a better chance of getting the Ombudsman established.
In hospital practice, pay scales do not differentiate between the sexes.
In private practice, Medicare’s schedule fees do not differentiate between the providers on the basis of their sex.
So how does a gender difference arise, if the pay scales are the same (& have been for decades)?
Are the data from USA applicable to Australia? Are the hours worked by the two sexes different?
The gap reported should be dissected out for us, in the same way that all scientific results are analysed, so that understanding & any necessary action can be supported.