SGEM#248: She Works Hard for the Money – Time’s Up in Healthcare

Date: March 8th, 2019

Reference: Wiler et al. Continuation of Gender Disparities in Pay Among Academic Emergency Medicine Physicians. AEM March 2019.

Guest Skeptic: Dr. Esther Choo. She is an emergency physician and researcher who studies health disparities, substance use disorders, and gender bias. Esther is an Associate Professor at Oregon Health and Sciences University and also is a founding member of the non-profit TIME'S UP Healthcare.

This SGEMHOP was recorded on International Women's Day. It was the SGEM's part in the Time's Up in Healthcare initiative.
The clock has run out on sexual assault, harassment and inequity in the healthcare workplace. It's time to do something about it.
Here is some more information on Time's Up in Healthcare:

Can we put an end to gender inequality and harassment in medicine? BMJ 2019
Time’s Up Tackles Gender Bias and Harassment in Health Care. Scientific American March 2019
Men in Medicine Speak Out Against Harassment in Powerful 'TIME'S UP Healthcare' Video. Men's Health March 2019
Health Organisations Slow to Tackle Inequality. Financial Times March 2019
Time’s Up Takes on Sexual Abuse and Discrimination in Healthcare. InStyle February 2019

Case: A women colleague is being hired for an emergency department attending job wants to know why her pay is less than that of a man at the same hospital with the same years of training and the same accomplishments?

Background: Salary disparity between men and women has existed forever, and despite efforts such as the Equal Pay Act of 1963, this disparity continues to exist. This gap is seen across numerous professions, including law, marketing, administration and medicine. In the United States, women working full time are typically paid just 80 percent of what men are paid (1-4).

According to one 2010 analysis, the disparity in medicine is one of the highest for any professional industry, trailing only dentistry (5). Women now represent half of medical school graduates and 38% of faculty members in U.S. medical schools (6). After controlling for multiple factors, including specialty, age, faculty rank and metrics of productivity, male physicians earned nearly $20,000 more per year than their female counterparts (7,8). Within emergency medicine, studies have shown female faculty are paid 10% to 13% less than males (9,10).

In Canada, this gender disparity also exists and occurs across specialties and within academia.

Why are Women Still Earning Less than Men in Medicine? CMAJ 2018
Why is There a Gender Wage Gap in Canadian Medicine? Healthy Debate 2018

Clinical Question: Is there a difference in compensation for men and women emergency physicians practicing in the United States?

Reference: Wiler et al. Continuation of Gender Disparities in Pay Among Academic Emergency Medicine Physicians. AEM March 2019.

Population: Academic emergency medicine physicians in the United States
Intervention: No intervention, this was a cross-sectional observational study of academic emergency physician salaries across the United States. It was done over 4 years from 2013-2017 (excluding 2014).
Comparison: Women vs. men emergency physicians
Outcome: Adjusted median annual base salary for physicians

Dr. Jennifer Wiler

This is an SGEMHOP episode which means we have the lead author on the show. Dr. Jennifer Wiler is a Professor and Executive Vice Chair, Department of Emergency Medicine, CU School of Medicine; and Professor, CU School of Business. She has served in numerous state and national leadership positions including Chair of the American Medical Association Women Physicians Congress.
Authors’ Conclusions: “Despite previously published data showing an inappropriate gender salary gap in emergency medicine, this gap has remained essentially unchanged over the past four years.”
Quality Checklist for Observational Study:

Did the study address a clearly focused issue? Yes