more_vert
FEMALE specialists are earning less than their male colleagues and the inequity is considerable, according to one of the few surveys of specialist incomes conducted in Australia.
Compared with their male counterparts, female medical specialists are earning almost 17% less, according to the report released last week by the Melbourne Institute at the University of Melbourne.
“The large gender differential has implications for health care costs, as the proportion of female graduates is now around 55%,” the report’s authors wrote.
The overall self-reported average pre-tax specialist income adjusted for age, experience and hours worked was $316 570, based on a sample of more than 3700 specialists, from the public and private sectors.
Annual earnings of self-employed specialists exceeded those of salaried hospital-based specialists by close to 27%.
The big earners
The highest paid specialists included diagnostic radiologists and orthopaedic surgeons, followed by other surgeons, obstetricians and gynaecologists, and intensive care specialists.
Psychiatrists, paediatricians and thoracic medicine specialists were the lowest earners.
Greater experience, less complex patients, college fellowship, more time spent in clinical work and working in regional areas were all factors that increased income.
“These variations are likely to arise from differences in the cost and length of the requisite training in each specialty, the complexity of skills required, the market conditions for specialist services, and historical relativities in the Medicare Benefits Schedule,” the authors wrote.
“It would be of interest to explore whether the pay differentials between specialists are in line with demand for these specialties (and potential shortages), or whether they are mainly driven by the cost of training and complexity of required skills,” they said.
Specialists better off in some states
Specialist incomes also varied by geographical location. Compared with specialists based in NSW, those in Western Australia earned 7.3% more and those in Queensland 14.6% more.
Specialists in regional areas also trumped their city-based colleagues, earning close to 6% more, but those working in Tasmania earned 12.9% less than their NSW peers.
Hours worked
The analysis showed the mean weekly hours worked by both male and female specialists was around 45 hours, and annually, 51.6 weeks.
General practice
Like their specialist counterparts, female GPs earned less than their male colleagues but the difference was greater, at 25% less than men.
GPs working in larger practices, regional and rural areas and areas where the supply of GPs is low had higher earnings, but the mean gross annual personal income for a GP was $177 883, more than 30% less than specialists.
Predictably, self-employed GPs and those who do on-call and after-hours work had higher incomes.
Gender divide a surprise
The report’s principle investigator, Professor Tony Scott, said in a media statement that the gender gap was surprising given that men and women in medicine had the same level of education.
“Our results have adjusted for differences in hours worked, years of experience, and a host of other factors. It could be that female doctors see a different mix of patients than male doctors,” he said.
“We are puzzled and will continue to look into this,” said Professor Scott, who leads the Health Economics Research program at the Melbourne Institute in Victoria.
The analysis is based on data collected from the national longitudinal survey of doctors called Medicine in Australia: Balancing Employment and Life (MABEL).
Full report: What Factors Influence the Earnings of GPs and Medical Specialists in Australia? Evidence from the MABEL Survey.
Posted 26 July, 2010
Two points. One, private practice income needs to consider private practice costs. These include rent, secretary, power, water, phone, insurances. I was a bit shocked that private practitioners only earned 27% more. That 27% would barely cover practice costs. Two, I work with a number of female specialists. They earn less because they don’t do after hours or weekends and take on patients who are less likely to require care outside of an “office” setting. That is a lifestyle choice and I see no issue with it. There is a hidden problem. We know that female specialists work on average 0.4 FTE with little work after hours or weekends. However, we did not increase training numbers to accommodate the loss of FTE specialists. This has resulted in an even greater workload taken on by male specialists which is worsening as their mostly male colleagues retire.
Does the current data available offer any insight into whether practitioner earnings or gender have any relationship to the number of adverse patient events or to patient satisfaction? Are patients happy following short, procedural consultations attracting high billings? Do they report satisfaction with longer, lower-billing consults dealing with psychosocial issues? Are they in fact appreciative of bulk-billing practitioners, or do they generally accept paying significant gap fees as the reasonable cost of access to quality care? Do the high- or low-billing consultations make the practitioner more at risk of personally and financially costly medicolegal battles? Which type of consultations are more likely to bring the practitioner a sense of achievement and satisfaction in their work? Can we quantify the benefits or risks of different consultation types in terms other than their capacity to attract income for the practitioner? As some other comments have alluded to, it appears meaningless to discuss earnings and gender in isolation from other personal and professional inter-practitioner differences.
As a non-proceduralist specialist, I too feel that the AMA’s campaign with respect to the reduction of reimbursement for ophthalmologists was unseemly when viewed in the light of relative incomes.
Why so many anonymous posts? is this a taboo subject?
My reading of some of the findings of the longitudinal Australian BEACH study of General Practice demonstrates that where there are psychological or social issue in the consultation, it is a longer consultation. More long consults, therefore fewer consults, means lower overall income. This means that those doctors who have more patients with psychosocial issues will tend to have longer consultations, especially if they are responding to those issues as part of the consultation. Thus male GPs who do more mental health or Indigenous health will have similar incomes to female GPs who are doing more mental health, etc. It is possible to extrapolate these findings for female gynecologists, who will have lower incomes, seeing more psychosocial referrals.
Does the (male, specialty dominated) AMA see this as a problem?
It is interesting that the commentary does not touch upon issues of cost-utility of differing fields and areas of practice.
This current payment model drives increasing privatisation and inequity of access to treatment – are we as doctors concerned by this?
“Is there any reason anyone can think of that neonatologists earn so little while intensive care specialists earn so much? “
1) supply and demand (mainly)
2) the multiple options ICU physicians have to make $$$ in the private sector probably pushes up public salaries, fewer (?no) jobs in the private sector for the paediatric ICU practitioners
This is pretty obvious really, and feminist theory is pretty irrelevant to the matter.
Not sure what the point of all this is.
Would be more meaningfull if the top earners were taken off (there are some who make millions per annum- and I ain’t one of them))
or better the medicare rebates were discussed rather than gross or net incomes if a gender difference is being assessed, or separate the public per hour rates to separate the longer workers vs the shorter workers (are we trying to prove that women work less – a social choice) or that they are paid in a different manner.
This is a political survey, not a scientific one allowing anyone to make capital of it in any way they wish.
The article clearly states that the study controlled for number of hours worked, so fewer female hours is *not* contributing to the pay gap. Interesting how many comments sum this up as the fault of the individual female. I think there is historical bias towards the specialties which are dominated by women, particularly paediatrics. As a pathologist in the private sector my income is around the median quoted by the article, and I work strictly business hours. A friend of mine, a neonatologist, works in the public system and earns at least 100K less for far more hours and punishing on-call. Is there any reason anyone can think of that neonatologists earn so little while intensive care specialists earn so much? Because apart from the gender difference in the make up of the specialty, or perhaps even a societal bias against the needs of critically ill children as opposed to adults, I can’t think of any.
has anyone looked at the hours worked ?
many male specialists I know work 8 days a week, 400 days a year and are on call day and night always. whereas some female specialists I know are never around nor contactable outside of Mon- Fri 9 – 5
I am curious to know whether the quoted pre-tax income of $316570 is after all the expenses of running a private practice has been deducted. If this is the figure derived from gross income subtracting the expenses, then it is pretty good.
I don’t really understand the article. Public hospital employees are employed on standard agreements. There is no ability to adjust the contracts with regard to sex. And in private we can charge what the market will bear (if we want). Any female could charge 50% more than me for anaesthesia if they wanted to try it. I find it very hard to get excited by this article.
In my field, Psychiatry, from my experience of discussions on college committees, there is a marked tendency for female colleagues to reduce fees, or even bulk-bill, more than male practitioners, and for some to be a little disapproving of those of us who don’t do so to the same extent.
On the other issue of the investigators stating income relates to the skills required…….excuse me but are we saying that a pediatrician in emergency or a neonatologist earn less than arthropods in private because they aren’t as skillful……no this purely relates to the market. Psychiatrists earn the least amongst specialists as they serve (or should serve) the poorest and most disenfranchised in our community. When the AMA comes out against ophthalmologists getting a pay cut yet doesn’t strongly support Medicare reform for non proceduralists it shows where the professions priorities are.
Designing training courses with young mothers in mind is crucial if women are going to enter medicine as a career. I myself would have specialised as a physician if I had not wanted a family and if I hadn’t graduated at the age of 26. I calculated that, even if I passed the exams first time, and did no post-fellowship training, I would not qualify as a specialist until I was 35. There wasn’t even any part-time work or job sharing arrangements back then. With the lengthening of the medical course, often to 7 years as I understand it, many female doctors will not have the opportunity to have a family.
Now, I work as a GP, and my husband, an anaesthetist, earns twice the hourly rate that I do. I would think twice before advising any young woman to do medicine now.
I agree that it’s important to see the detail of how these figures have been generated, before the stereotyped concept of gender inequality is further perpetuated inaccurately. For example, the example given of the apparent gender gap being greatest in GP (where there is absolutely no institutional bias favouring male incomes) suggests to me that the income differences are in the individual practitioners’ control (eg. length of consult, billing practices, after hours penalties, time devoted to non-income generating activities etc.) Also, using level of education belies quite different experiences of how those levels of education were achieved, with some people taking twice as long to achieve fellowship, thus moving up incremantal pay scales at different rates. Lastly, I think it’s important that we don’t perpetuate the concept that women have to be the ones providing childcare, and whilst we (as a society) chose to let that happen currently, there is no valid reason that this should persist beyond the breast feeding stage of child-rearing. Allowing/encouraging fathers to share the role might result in a change to the apparent inequity, whatever the reasons (real or spurious) turn out to be.
Would have to agree with Audie. In Anaesthetics the duration of consultations is likely to be similar with both genders but female collegues seem to accept less for the same work. Is this a differing concept of self worth or simply pragmatism?
In my field (Gynaecology) it is well recognised that female specialists receive a different subset of referrals – often more psychosocially complicated and less likely to be seeking surgery. Most female gynaecologists have long waiting lists for appointments as our books are filled with “non-surgical” referrals. Patients requiring surgery are often more prepared to see a male specialist – hence the male specialists consulting sessions generate a much greater proportion of surgical cases. Given the extremely poor rebate for consultations it is no surprise that female gynaecologists earn a lot less for the same number of hours worked. Many female gynaecologists struggle to fill their operating lists despite spending countless hours consulting – often seeing patients who could have been looked after by a good GP, for their routine smears, gynae checks, hormonal and sexual issues. This can actually make it quite difficult to meet practice expenses, let alone take home a decent income, unless some sort of triaging is performed by practice staff. We can also be at risk of losing our surgical skills, not to mention feeling a bit miffed about the whole inequity of the referral pattern.
I don’t think this comparision has been analysed in detail. Are the figures generated by specialty and sex or has it been rolled up by income and then sliced by just specialty or by sex? An important factor may have been ignored especially with the fact a specialty like Ortho is predominantly male oriented which can skew the data. I think the data should be presented to summarise these conclusions.
The fact that female GPs and female specialists earn less than their male colleagues could be attributed to longer consultations with increased likelyhood of bulk billing or reduced fees. Do female practitioners want to change this? Is it just a “boy – girl” thing?
I imagine that more women doctors, particularly GPs, work part-time or fewer hours overall in order to maintain a family-friendly lifestyle. I’m surprised that Tony Scott wouldn’t immediately identify this as a potential contributing factor to the earning gap. Making sure that all specialty training is, in part, designed with female trainees in mind – women who may need to take time out of the workforce or job-share while raising young children – should be a priority.
It is well known that female doctors take more time for each consultation, which translates to lower earning for unit time worked. It would be of interest to see if female specialist doctors work more in the public than private sector, which also attracts less earning per unit time; the public sector is more accommodating to the balance work and family.
Having been through specialist training myself, and working through maternity leave to complete a PhD, the demands of parenting are greater for females than males, even in today’s support structure for gender equity.