Sex Differences in Salaries of Department Chairs at Public Medical Schools

Women in academic medicine are paid less than their male peers.^1,2 This salary difference is often attributed to differences in rank and promotion. The goal of this study was to investigate whether sex pay differences exist at the highest ranks of academic medicine: among clinical department chairs. Given that department chairs are exceptional leaders who have reached the top rank of their specialties, we hypothesized that there would be no significant differences in salary between female and male department chairs.

We extracted 2017 salary data from 29 state medical schools in 12 states that had public employee salary data available online. We included all 20 Accreditation Council for Graduate Medical Education pipeline specialties (leading to board certification) with more than 80 residency training programs nationwide from 2016 to 2017.³ We used websites to identify chairs of each clinical department as described previously.² If no chair could be identified, division chiefs, interim, or acting chairs were identified. Two authors (M.M. and W.B.) independently verified chair identities and term lengths through press releases, newsletters, Doximity, and LinkedIn. Peer-reviewed scientific publications were identified through PubMed, and lifetime National Institutes of Health grants were identified through the National Institutes of Health Reporter. This study was exempt from institutional review board because it represents research on organizations rather than individuals; as such, no written or oral consent was obtained. Data were gathered between November 1, 2018, and January 31, 2019.

Analysis began February 2019. We calculated adjusted salary differences using linear regression of log-transformed inflation-adjusted 2017 earnings, controlling for title (eg, permanent vs interim), term length, specialty, and regional cost of living. We conducted 3 sensitivity analyses. Our first sensitivity analysis removed potentially erroneously low salaries by excluding interim department chairs and chairs at schools where most chairs were compensated below three-fourths of the 25th percentile within their specialty. Our second sensitivity analysis controlled for numbers of publications and National Institutes of Health grants. Our third sensitivity analysis controlled for publications and grants and additionally controlled for differences in state databases reporting by including database-level fixed effects. Two-sided P values with a significance threshold less than .05 were used.

Our sample consisted of 550 department chairs across 29 US public schools of medicine (Table 1), representing almost half of public medical school department chairs whose salaries were reported to the Association of American Medical Colleges from 2017 to 2018 (N = 1073).⁴ A total of 92 chairs (16.7%) were women. The unadjusted mean difference in annual salary by sex was $79 061 (95% CI, $23 103-$135 020; P < .01; mean [SD] for men: $452 359 [$252 411] and for women: $373 298 [$196 304]). After adjusting for term length, specialty, inflation, title, and regional cost of living differences, the salary difference by sex was $67 517 (95% CI, $13 474-$121 561; P = .02). Sex salary differences persisted in sensitivity analyses additionally controlling for academic productivity and salary database (Table 2). Among chairs who served for more than 10 years, men were paid significantly more than women ($127 411 [95% CI, $55 028-$199 793]; P < .01).

Our study shows sex differences in salaries of clinical department chairs in US public medical schools. After adjusting for academic productivity and multiple other factors, women earned $0.88 for every dollar received by men.

Limitations include lack of data to account for race/ethnicity or the Northeast. Additionally, chair compensation reported in public data was generally lower than compensation reported in Association of American Medical Colleges public medical school faculty survey reports.⁴ This may reflect exclusion of medical practice earnings and bonus pay in our data. However, we do not believe including these forms of compensation would substantially change our conclusions because our sensitivity analysis excluding potentially erroneously underreported salaries increased observed sex differences in salary.

The observed salary disparities reveal the pervasiveness of sex inequity even at the highest levels of academic medicine’s hierarchy. These findings call into question common historical justifications for sex inequities in salary, as the women in our sample have demonstrated career commitment and negotiation experience. Our findings suggest that structural, rather than individual, solutions are needed to achieve sex salary equity.

Corresponding Author: Eleni Linos, MD, DrPH, Department of Dermatology, Stanford University Medical Center, 269 Campus Dr, CCSR 4325, Stanford, CA 94305 (linos@stanford.edu).

Accepted for Publication: December 31, 2019.

Published Online: March 2, 2020. doi:10.1001/jamainternmed.2019.7540

Author Contributions: Dr Mensah had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Linos and Mangurian contributed equally to senior authorship.

Concept and design: Mensah, Rotenstein, Jagsi, Linos, Mangurian.

Acquisition, analysis, or interpretation of data: Mensah, Beeler, Rotenstein, Jagsi, Spetz, Mangurian.

Drafting of the manuscript: Mensah, Beeler, Linos.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Mensah, Spetz, Linos.

Administrative, technical, or material support: Mensah, Beeler, Rotenstein, Linos, Mangurian.

Supervision: Linos, Mangurian.

Conflict of Interest Disclosures: Dr Mensah reports grants from American Psychiatric Association Substance Abuse and Mental Health Services Administration Minority Fellowship outside the submitted work; serves on the American Psychiatric Association Board of Trustees as Resident Fellow Member Trustee Elect; and serves as a fellow on the Group for the Advancement of Psychiatry Forensic Committee. Dr Beeler serves on the Accreditation Council for Graduate Medical Education Radiation Oncology Review Committee and Council of Review Committee Resident outside the submitted work. Dr Rotenstein reports honoraria from the Kansas Foundation for Medical Care and MedStar Georgetown University; is founder of CareZooming; and serves on the Society for General Internal Medicine Clinical Practice Committee outside the submitted work. Dr Jagsi reports grants from National Institutes of Health/National Cancer Institute, Doris Duke Charitable Foundation, Susan G. Komen for the Cure, Greenwall Foundation, and Blue Cross Blue Shield of Michigan; personal fees from Greenwall Foundation, Amgen, and Vizient; stock options from Equity Quotient; and is an uncompensated founding member of TIME’S UP Healthcare outside the submitted work. Dr Spetz reports grants from US Health Resources and Services Administration, National Institute of Dental and Craniofacial Research, Agency for Healthcare Research and Quality, National Institute on Drug Abuse, Robert Wood Johnson Foundation, National Council of State Boards of Nursing, George Washington University, and Massachusetts Health Policy Commission; contracts with California Board of Registered Nursing and contracts with Human Services Agency of San Francisco; personal fees from Massachusetts Health Policy Commission, AARP, Health Management Associates, Planned Parenthood Federation of America, UnitedHealth Group’s Center for Clinician Advancement, Kaiser Foundation Health Plans, Sigma Theta Tau, Los Angeles Chapter, and Project HOPE outside the submitted work; serves on the membership committee of AcademyHealth; and serves as chair of the Health Workforce Interest Group of the International Health Economics Interest Group. Dr Linos is supported by National Institutes of Health (grants K24AR075060 and DP2CA225433). Dr Mangurian reports grants from National Institute of Mental Health, Doris Duke Charitable Foundation, and California Health Care Foundation; personal fees from New England Journal of Medicine, American Psychiatric Association, American Academy of Pediatrics, and Uncommon Bold outside the submitted work; and is an uncompensated founding member of TIME’S UP Healthcare.