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Invited Commentary
Diversity, Equity, and Inclusion
February 18, 2022

Measuring and Mitigating Gender-Based Disparities in Earning Potential in Academic Medicine

Author Affiliations
  • 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
JAMA Netw Open. 2022;5(2):e220074. doi:10.1001/jamanetworkopen.2022.0074

The article by Catenaccio et al1 models the early career earning potential for women and men in academic medicine, finds disparities in projected earning potential, and determines that starting salaries are the primary factor associated with these disparities. This is an important finding, despite the limitations of this kind of modeling. Here, we discuss some of the limitations of estimating long-term earning potential and describe options to reduce the differential.

Calculations of long-term earning potential are based on a series of assumptions. One of the most important is the assumed discount rate, which reflects the amount people are willing to trade off between dollars available today and dollars available in the future. Catenaccio et al1 use the US July 2019 discount rate of 3%, which assumes a person should be indifferent between earning $97 today or $100 next year. However, retrospective data show large variations in the discount rate people are willing to accept.2 For example, over the course of the last 20 years, the US discount rate has ranged from 0.5% to 6.25%.2 Discount rate fluctuations, which are associated at least in part with differing rates of inflation, demonstrate the limitation of using the 3% assumption. If the actual discount rate were lower, the differential in earning potential between men and women would be greater.3

Catenaccio et al1 factored other important assumptions into the calculation of earning potential, including the assumption that there was no time off between an individual's multiple educational and training programs and between training completion and employment. They showed that changes in assumptions, such as how long it takes to be promoted, are also associated with differences in earning potential between female and male physicians.1 Because physician compensation in academic medicine is often linked to factors such as external research funding and clinical productivity, assumptions about these factors may also be associated with differences in earning potential, providing additional areas to target to promote compensation equity between female and male physicians.

Catenaccio et al1 also discuss several options to reduce the differentials. On the basis of their analysis, the preferred option is to equalize the starting salaries, and in some academic institutions this is already occurring. There are still problems in specialties dominated by men, which are more likely to lead to gender inequities in compensation and earning potential. Because physician compensation is partially related to the resource-based relative value scale, which assumes that physician services should be reimbursed according to the costs of resources needed to provide the services, it is important to review the resource-based relative value scale across specialties from the perspective of gender equity.4

To equalize starting salaries, transparency may be a healthy first step. Sharing benchmark data when negotiating compensation with new physician hires may help increase parity.5 Conversely, prohibiting employers from seeking information about the salary history of a prospective employee during compensation negotiations—a provision established by law in states such as Massachusetts, New York, and Philadelphia—may protect women physicians from carrying forward the penalties imposed by lower starting salaries.6 Requiring employers to justify differences in salaries between men and women who perform the same job, such as implemented in California by the California Fair Pay Act of 2015, may incentivize employers to provide compensation parity from the start.7

As Catenaccio et al1 demonstrate, for women who have been in academic medicine for many years, if they started at a lower salary, they likely have a lower salary than men, even with an equivalent number of years in the profession, rank, and academic productivity. To address this historic inequity, we recommend that academic organizations perform periodic compensation evaluations and adjustments. There are 2 ways to implement such adjustments. The first is comparing the salaries of female and male physicians who perform equivalent work (a like-for-like gap analysis), and the second is comparing the average salaries of female and male physicians across a given institution (an organizational-level gap analysis).7 In both cases, it is important that the analyses take into account the complexities of physician compensation beyond the negotiated salary, examining aspects such as bonuses, clinical incentives, compensation for leadership positions, and others, while also recognizing these are often differentially provided to men.

To close the gap in lifetime earnings between female and male physicians working in academic medicine, the data from Catenaccio and colleagues1 suggest several avenues for reducing the gender gap in lifetime earning potential. These avenues include (1) ensuring that starting salaries are similar across genders, (2) providing women who are already in the workforce periodic opportunities to get their compensation reviewed and adjusted, and (3) offering women equitable opportunities to increase their earning potential, such as opportunities for leadership positions.

Seeking gender parity in physician compensation should not only be the goal of individual physicians and the institutions that employ them. Public policies can significantly help advance compensation equity. State-level initiatives, such as the California Fair Pay Act of 2015 and the Massachusetts Equal Pay Act updated in 2018,6,7 are examples of policies that benefit not only women physicians, but women across the entire workforce.

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Article Information

Published: February 18, 2022. doi:10.1001/jamanetworkopen.2022.0074

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Socal MP et al. JAMA Network Open.

Corresponding Author: Gerard F. Anderson, PhD, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205 (ganderson@jhu.edu).

Conflict of Interest Disclosures: Dr Socal reported receiving grants from Arnold Ventures during the conduct of the study. Ms Liu reported receiving grants from Arnold Ventures during the conduct of the study. Dr Anderson reported receiving grants from Arnold Ventures during the conduct of the study. No other disclosures were reported.

Funding/Support: Drs Socal and Anderson and Ms Liu received research grants from Arnold Ventures.

Role of the Funder/Sponsor: The funder 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.

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