Gender Gaps in Salary and Representation in Academic Internal Medicine Specialties in the US | Health Care Workforce | JAMA Internal Medicine | JAMA Network
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Figure 1.  Gender-Based Salary and Representation Disparities in Internal Medicine in 2018 to 2019
Gender-Based Salary and Representation Disparities in Internal Medicine in 2018 to 2019

A, Median annual salary for women was uniformly lower compared with men across all faculty levels within internal medicine. Female representation was nearly equal at the most junior faculty rank but declined with each rank of faculty promotion. B, Median annual salary for women was lower compared with men across internal medicine specialties but reached higher than 90% of male salaries in 10 of 13 specialties (blue line, right y-axis).

Figure 2.  Gender-Based Salary Disparities in Internal Medicine Specialties in 2018 to 2019, by Rank
Gender-Based Salary Disparities in Internal Medicine Specialties in 2018 to 2019, by Rank

Median women’s salary as a percentage of men’s salary, by specialty and faculty rank. Men’s salaries surpassed women’s salaries in 56 of 62 categories of faculty rank in 13 internal medicine specialties. Equivalence point of women’s and men’s salaries is displayed as the black line at 100%.

1.
AAMC Statement on Gender Equity. AAMC. Accessed November 14, 2020. https://www.aamc.org/what-we-do/diversity-inclusion/aamc-statement-gender-equity
2.
Richter  KP, Clark  L, Wick  JA,  et al.  Women physicians and promotion in academic medicine.   N Engl J Med. 2020;383(22):2148-2157. doi:10.1056/NEJMsa1916935PubMedGoogle ScholarCrossref
3.
AAMC Faculty Salary Report. AAMC. Accessed April 29, 2021. https://www.aamc.org/data-reports/workforce/report/aamc-faculty-salary-report
4.
Mensah  M, Beeler  W, Rotenstein  L,  et al.  Sex differences in salaries of department chairs at public medical schools.   JAMA Intern Med. 2020;180(5):789-792. doi:10.1001/jamainternmed.2019.7540PubMedGoogle ScholarCrossref
5.
Whaley  CM, Arnold  DR, Gross  N, Jena  AB.  Practice composition and sex differences in physician income: observational study.   BMJ. 2020;370:m2588. doi:10.1136/bmj.m2588PubMedGoogle Scholar
6.
Bravender  T, Selkie  E, Sturza  J,  et al.  Association of salary differences between medical specialties with sex distribution.   JAMA Pediatr. 2021;175(5):524-525. doi:10.1001/jamapediatrics.2020.5683PubMedGoogle ScholarCrossref
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    1 Comment for this article
    Science or Politics?
    Arturo Irarrazaval, Ophthalmologist | Consultores Oftalmologicos
    Why is it that in the last months/years a great part of this journal is about gender, race, ethnicity, or the economy? Please, a little more medicine!
    CONFLICT OF INTEREST: None Reported
    Research Letter
    Physician Work Environment and Well-Being
    July 12, 2021

    Gender Gaps in Salary and Representation in Academic Internal Medicine Specialties in the US

    Author Affiliations
    • 1Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
    • 2Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
    JAMA Intern Med. 2021;181(9):1255-1257. doi:10.1001/jamainternmed.2021.3469

    Women comprise 41% of faculty in full-time academic positions, steadily increasing since 2009.1 The number of women pursuing Internal Medicine (IM) careers continues to rise; however, gender differences in physician salary and promotion have endured.2 Contemporary data on the workforce composition of IM subspecialist physicians are lacking. We sought to evaluate current demographics and salaries of academic IM physician specialists and hypothesized that gender disparities in remuneration persist despite the increase in female representation in academic IM.

    Methods

    In this cross-sectional analysis, we examined the most recently available summary survey data on academic physician salaries from the 2018 to 2019 Association of American Medical Colleges (AAMC) Faculty Salary Report,3 spanning fiscal year 2018 to 2019. Data were deidentified and therefore not subject to institutional review board approval per University of Pennsylvania protocols. Institutional survey respondents provided total compensation rounded to the nearest thousand for each full-time faculty member, which were then aggregated. We report descriptive statistics on median annual salary, faculty rank, and gender for 21 905 faculty within 13 IM specialties at 154 United States medical schools. Female representation was calculated as a proportion of total faculty count.

    Results

    In 2018 to 2019, women comprised fewer than 50% (8662/21780) of total full-time faculty across all ranks. Although female representation was nearly equal at the instructor (715/1512 [47%]) and assistant ranks (4828/10457 [46%]), it decreased to 24% at higher ranks (female professor, 1057/4340) (Figure 1A). Women were the majority in 3 specialties: general IM, endocrinology, geriatrics. Procedural specialties (pulmonology, critical/intensive care, gastroenterology, cardiology) had the fewest female faculty. Cardiology exhibited the greatest imbalance with only 21% (664/3112) women (Figure 1B).

    Women’s median annual salary was lower across all faculty ranks but remained within an absolute difference of $25 000 at all ranks except for Chief. When analyzed by IM specialty, women were paid at least 90% of men’s median annual salary in 10 of 13 IM specialties. However, when examined by rank, men’s salaries still exceeded women’s in 56 of 62 categories (90%). The 3 specialties in which women’s median salary did not reach 90% of men’s—cardiology, gastroenterology, critical/intensive care—tended toward higher remuneration in total but also demonstrated the largest gender disparities in both representation and salary, particularly within the higher ranks of cardiology and gastroenterology (Figure 2).

    Discussion

    Our analysis of the 2018 to 2019 AAMC Faculty Salary Report from 154 US medical schools demonstrates persistent salary differences by gender and representation disparities in IM specialties, despite the increasing number of women in IM. We found that nonprocedural IM specialties exhibited closer parity in both salary and representation, whereas procedural specialties had low female representation with the largest salary disparities.

    Within IM, unadjusted salary differences between genders appear to be improving over time. Yet, substantial salary inequities persist at the highest faculty levels and specifically in procedural-based specialties.4 Our findings regarding the disparities in procedural IM specialties align with recent works that examined both academic and nonacademic physician salaries and found that the largest gender differences in salary across multiple medical and surgical specialties existed among specialties and practices with the highest proportion of male physicians.5,6 The reasons for this remain unclear; IM procedural specialties have long been male dominated in composition and leadership, despite increasing gender parity in the preceding training stages. Taken together, these findings suggest that workforce gender parity was associated with salary equity, and further investigation of the disparities in procedural specialties is needed.

    Limitations include inability to adjust for additional individual-level factors that may affect salary, including professional service, academic productivity, clinical volume, and ancillary funding sources, and these factors are likely also influenced by gender, race, and geography. Our findings may not be generalizable across all US medical schools given the heterogeneity in IM departmental structures. Despite the influence of potential confounders, these unadjusted gender-disaggregated data provide important insights regarding physician workforce composition and salary.

    Our findings suggest that salary disparities persist in US IM specialties and are most pronounced in procedural specialties with fewer women. These findings emphasize the importance of gender diversity to achieving salary parity in IM subspecialties and highlight opportunities to improve representation and salary equity in IM procedural specialties.

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    Article Information

    Accepted for Publication: May 25, 2021.

    Published Online: July 12, 2021. doi:10.1001/jamainternmed.2021.3469

    Corresponding Author: Nosheen Reza, MD, Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, 11 South Tower, Room 11-145, Philadelphia, PA 19104 (nosheen.reza@pennmedicine.upenn.edu).

    Author Contributions: Drs Wang and Reza had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Wang, Reza.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Wang, Reza.

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

    Statistical analysis: Wang, Reza.

    Administrative, technical, or material support: Douglas.

    Supervision: Douglas, Reza.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: Dr Reza is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number KL2TR001879.

    Role of the Funder/Sponsor: The National Institutes of Health had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

    References
    1.
    AAMC Statement on Gender Equity. AAMC. Accessed November 14, 2020. https://www.aamc.org/what-we-do/diversity-inclusion/aamc-statement-gender-equity
    2.
    Richter  KP, Clark  L, Wick  JA,  et al.  Women physicians and promotion in academic medicine.   N Engl J Med. 2020;383(22):2148-2157. doi:10.1056/NEJMsa1916935PubMedGoogle ScholarCrossref
    3.
    AAMC Faculty Salary Report. AAMC. Accessed April 29, 2021. https://www.aamc.org/data-reports/workforce/report/aamc-faculty-salary-report
    4.
    Mensah  M, Beeler  W, Rotenstein  L,  et al.  Sex differences in salaries of department chairs at public medical schools.   JAMA Intern Med. 2020;180(5):789-792. doi:10.1001/jamainternmed.2019.7540PubMedGoogle ScholarCrossref
    5.
    Whaley  CM, Arnold  DR, Gross  N, Jena  AB.  Practice composition and sex differences in physician income: observational study.   BMJ. 2020;370:m2588. doi:10.1136/bmj.m2588PubMedGoogle Scholar
    6.
    Bravender  T, Selkie  E, Sturza  J,  et al.  Association of salary differences between medical specialties with sex distribution.   JAMA Pediatr. 2021;175(5):524-525. doi:10.1001/jamapediatrics.2020.5683PubMedGoogle ScholarCrossref
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