Female Physicians Earn An Estimated $2 Million Less Than Male Physicians Over A Simulated 40-Year Career

Parenthood and Paychecks-The Gender Pay Gap in Medicine

This Viewpoint examines recent evidence on the gender pay gap in US medical professions and its relationship with motherhood (the motherhood penalty) and suggests opportunities for mitigating inequity that reflect the current health care environment, advance gender equity, and enhance medical practice.

Changes in high school students attitudes toward health sciences following a hands-on outreach STEM program

Despite attempts to diversify healthcare workplaces and education, racial and ethnic minorities (REM) remain underrepresented in these fields. This study investigated changes in high school students' health science interest following a single exposure, hands-on anatomy laboratory visit. One hundred and eighty-eight high school students participated in a single day, one-hour visit to a human anatomy laboratory on a university campus. Participants engaged in hands-on activities centered around both human and animal specimens led by university mentors. Using a modified Science Technology Engineering and Mathematics-Career Interest Survey (STEM-CIS) questionnaire, health science STEM interest was calculated before and after the visits and compared using a paired t-test (α = 0.05). A 2 × 2 ANOVA (α = 0.05) was run on pre-to-post-visit interest score differences with factors of Race (White/REM) and Gender (Male/Female) to determine if race/ethnicity and/or gender moderated the gains observed. Overall, health science STEM interest increased significantly from pre- to post-visit (p < 0.001), and these gains were greater in REM students (p < 0.05) but did not differ as a function of gender. These findings indicate that a single visit to an anatomy laboratory with hands-on activities can be used as a tool to engage high school aged students in STEM and may be particularly beneficial for racial/ethnic minority students, potentially influencing health science STEM interest.

Association of Gender and Personal Choices with Salaries of New Emergency Medicine Graduates

Objective

The medical literature has demonstrated disparities and variability in physician salaries and, specifically, emergency physician (EP) salaries. We sought to investigate individual physician characteristics, including sex and educational background, together with individual preferences of graduating EPs, and their association with the salary of their first job.

Methods

The American College of Emergency Physicians and the George Washington University Mullan Institute surveyed 2019 graduating EPs. The survey included respondents' demographic and educational background, post-training job characteristics and location, hospital characteristics, importance of different personal priorities, and starting salaries. We performed a multivariable regression analysis to determine how salaries were associated with job types and individuals' characteristics.

Results

We sent surveys to 2,192 graduating residents in 2019. Of these, 487 (22.2%) responded, and 270 (55.4%) accepted first-time clinical jobs and included salary data (12.3% of all surveys sent). Male sex, osteopathic training, and full-time work were significantly associated with higher salary. Men and women prioritized different factors in their job search. Women were more likely to consider such factors as parental leave policy, proximity to family, desired practice setting, type of hospital, and desired location as important. Salary/compensation was considered very important by 51.8% of men and 29.6% of women. Men's median salary was $30,000 more than women's (p = 0.01, 95% CI +$6,929 -+$53,071), a significant pay differential.

Conclusion

Salaries of graduating emergency medicine residents are associated with the resident's sex and degree type: doctor of osteopathic medicine or doctor of allopathic medicine. Multiple factors may contribute to men having higher salaries than women, and some of this difference reflects different priorities in their job search. Women were more likely to consider job conditions and setting to be more important, while men considered salary and compensation more important.

Associations Between Organizational Support, Burnout, and Professional Fulfillment Among US Physicians During the First Year of the COVID-19 Pandemic

GOAL

This research aimed to evaluate variations in perceived organizational support among physicians during the first year of the COVID-19 pandemic and the associations between perceived organizational support, physician burnout, and professional fulfillment.

METHODS

Between November 20, 2020, and March 23, 2021, 1,162 of 3,671 physicians (31.7%) responded to the study survey by mail, and 6,348 of 90,000 (7.1%) responded to an online version. Burnout was assessed using the Maslach Burnout Inventory, and perceived organizational support was assessed by questions developed and previously tested by the Stanford Medicine WellMD Center. Professional fulfillment was measured using the Stanford Professional Fulfillment Index.

PRINCIPAL FINDINGS

Responses to organizational support questions were received from 5,933 physicians. The mean organizational support score (OSS) for male physicians was higher than the mean OSS for female physicians (5.99 vs. 5.41, respectively, on a 0-10 scale, higher score favorable; p < .001). On multivariable analysis controlling for demographic and professional factors, female physicians (odds ratio [OR] 0.66; 95% CI: 0.55-0.78) and physicians with children under 18 years of age (OR 0.72; 95% CI: 0.56-0.91) had lower odds of an OSS in the top quartile (i.e., a high OSS score). Specialty was also associated with perceived OSS in mean-variance analysis, with some specialties (e.g., pathology and dermatology) more likely to perceive significant organizational support relative to the reference specialty (i.e., internal medicine subspecialty) and others (e.g., anesthesiology and emergency medicine) less likely to perceive support. Physicians who worked more hours per week (OR for each additional hour/week 0.99; 95% CI: 0.99-1.00) were less likely to have an OSS in the top quartile. On multivariable analysis, adjusting for personal and professional factors, each one-point increase in OSS was associated with 21% lower odds of burnout (OR 0.79; 95% CI: 0.77-0.81) and 32% higher odds of professional fulfillment (OR 1.32; 95% CI: 1.28-1.36).

PRACTICAL APPLICATIONS

Perceived organizational support of physicians during the COVID-19 pandemic was associated with a lower risk of burnout and a higher likelihood of professional fulfillment. Women physicians, physicians with children under 18 years of age, physicians in certain specialties, and physicians working more hours reported lower perceived organizational support. These gaps must be addressed in conjunction with broad efforts to improve organizational support.

Gender-Based Variations in Medicare Reimbursements Among Different Surgical Subspecialties

Importance

Gender inequities and limited representation are an obstacle to surgical workforce diversification. There has been limited examination of gender-based disparities in billing practices among surgeons.

Objective

To evaluate variations in practice metrics and billing practices among female and male surgeons and identify factors associated with gender disparities in Medicare reimbursements.

Design, Setting, and Participants

This retrospective cross-sectional study used publicly available Medicare Fee-for-Service Provider Utilization and Payment data from January to December 31, 2021, to identify demographics, annual services provided, and financial payments and charges for general surgeons, surgical oncologists, and colorectal surgeons. Data were analyzed from November 2023 to February 2024.

Exposure

The primary exposure of interest was surgeon gender (ie, female or male).

Main Outcomes and Measures

The annual total submitted charges and payments submitted in 2021 by female and male surgeons were assessed. Additionally, the total number and types of services provided each year and the number of beneficiaries treated were examined. Multivariable linear regression models were used to evaluate the association of surgeon gender with payments, number of services, and beneficiaries.

Results

A total of 20 549 general surgeons (5036 [24.5%] female; 15 513 [75.5%] male), 1065 surgical oncologists (450 [42.3%] female; 615 [57.7%] male), and 1601 colorectal surgeons (432 [27.0%] female; 1169 [73.0%] male) were included. Across all surgical subspecialties, female surgeons billed fewer mean (SE) Medicare charges (general surgeons: 30.1% difference; $224 934.80 [$3846.97] vs $321 868.50 [$3933.57]; surgical oncologists: 27.5% difference; $277 901.70 [$22 857.37] vs $382 882.90 [$19 566.06]; colorectal surgeons: 21.7% difference; $274 091.70 [$10 468.48] vs $350 146.10 [$8741.66]; all P < .001) and received significantly lower mean (SE) reimbursements (general surgeons: 29.0% difference; $51 787.61 [$917.91] vs $72 903.12 [$890.35]; surgical oncologists: 23.6% difference; $57 945.18 [$3853.28] vs $75 778.22 [$2622.75]; colorectal surgeons: 24.5% difference; $63 117.01 [$2248.10] vs $83 598.53 [$1934.77]; all P < .001). On multivariable analysis, a reimbursement gap remained across all 3 surgical subspecialties (general surgeons: -$14 963.46 [95% CI, -$18 822.27 to -$11 104.64] [P < .001]; surgical oncologists: -$8354.69 [95% CI, -$15 018.12 to -$1691.25] [P = .01]; colorectal surgeons: -$4346.73 [95% CI, -$7660.15 to -$1033.32] [P = .01]).

Conclusions and Relevance

In this cross-sectional study, there was considerable gender-based variation in practice patterns and reimbursement among different surgical subspecialties serving the Medicare population. Differences in mean payment per service were associated with variations in billing and coding strategies among female and male surgeons.

Gender Differences in Electronic Health Record Usage Among Surgeons

Importance

Understanding gender differences in electronic health record (EHR) use among surgeons is crucial for addressing potential disparities in workload, compensation, and physician well-being.

Objective

To investigate gender differences in EHR usage patterns.

Design, Setting, and Participants

This cross-sectional study examined data from an EHR system (Epic Signal) at a single academic hospital from January to December 2022. Participants included 224 attending surgeons with patient encounters in the outpatient setting. Statistical analysis was performed from May 2023 to April 2024.

Exposures

Surgeon's gender.

Main Outcomes and Measures

The primary outcome variables were progress note length, documentation length, time spent in medical records, and time spent documenting patient encounters. Continuous variables were summarized with median and IQR and assessed via the Kruskal-Wallis test. Categorical variables were summarized using proportion and frequency and compared using the χ2 test. Multivariate linear regression was used with primary EHR usage variables as dependent variables and surgeon characteristics as independent variables.

Results

This study included 222 529 patient encounters by 224 attending surgeons, of whom 68 (30%) were female and 156 (70%) were male. The median (IQR) time in practice was 14.0 (7.8-24.3) years. Male surgeons had more median (IQR) appointments per month (78.3 [39.2-130.6] vs 57.8 [25.7-89.8]; P = .005) and completed more medical records per month compared with female surgeons (43.0 [21.8-103.9] vs 29.1 [15.9-48.1]; P = .006). While there was no difference in median (IQR) time spent in the EHR system per month (664.1 [301.0-1299.1] vs 635.0 [315.6-1192.0] minutes; P = .89), female surgeons spent more time logged into the system both outside of 7am to 7pm (36.4 [7.8-67.6] vs 14.1 [5.4-52.2] min/mo; P = .05) and outside of scheduled clinic hours (134.8 [58.9-310.1] vs 105.2 [40.8-214.3] min/mo; P = .05). Female surgeons spent more median (IQR) time per note (4.8 [2.6-7.1] vs 2.5 [0.9-4.2] minutes; P < .001) compared with male surgeons. Male surgeons had a higher number of median (IQR) days logged in per month (17.7 [13.8-21.3] vs 15.7 [10.7-19.7] days; P = .03). Female surgeons wrote longer median (IQR) inpatient progress notes (6025.1 [3692.1-7786.7] vs 4307.7 [2808.9-5868.4] characters/note; P = .001) and had increased outpatient document length (6321.1 [4079.9-7825.0] vs 4445.3 [2934.7-6176.7] characters/note; P < .001). Additionally, female surgeons wrote a higher fraction of the notes manually (17% vs 12%; P = .006). After using multivariable linear regression models, male gender was associated with reduced character length for both documentations (regression coefficient, -1106.9 [95% CI, -1981.5 to -232.3]; P = .01) and progress notes (regression coefficient, -1119.0 [95% CI, -1974.1 to -263.9]; P = .01). Male gender was positively associated with total hospital medical records completed (regression coefficient, 47.3 [95% CI, 28.3-66.3]; P < .001). There was no difference associated with gender for time spent in each note, time spent outside of 7 am to 7 pm, or time spent outside scheduled clinic hours.

Conclusions and Relevance

This cross-sectional study of EHR data found that female surgeons spent more time documenting patient encounters, wrote longer notes, and spent more time in the EHR system compared with male surgeons. These findings have important implications for understanding the differential burdens faced by female surgeons, including potential contributions to burnout and payment disparities.

Gender Disparity in Full Professor Rank Among Academic Physicians: A Systematic Review and Meta-Analysis

PURPOSE

The gender gap in promotion in academic medicine is well established. However, few studies have reported gender differences in promotion adjusted for scholarly production and national or international reputation, namely, career duration, publications, grant funding, and leadership positions. The authors performed a systematic review and meta-analysis of the differences between men and women in achieving benchmarks for promotion and analyze where such differences lie geographically and within specialties.

METHOD

A systematic search of Academic Search Premier, Business Source Complete, Cochrane Library, ERIC, GenderWatch, Google Scholar, Embase, MEDLINE, PubMed, Scopus, and Web of Science was conducted from inception to August 17, 2022. All studies that reported the number of male and female full professors on medical school faculty were included. The primary outcome was the adjusted odds ratio (AOR) for promotion to full professor for women compared with men.

RESULTS

Two hundred forty-four studies met the inclusion criteria. The unadjusted OR for promotion to full professor for women was 0.38 (95% confidence interval [CI], 0.36-0.41). Sixteen studies reported an AOR. The pooled AOR of promotion for women to full professor was 0.60 (95% CI, 0.46-0.77). The AOR for promotion to full professor was 0.55 (95% CI, 0.34-0.88) in surgery and 0.80 (95% CI, 0.57-1.11) in internal medicine. Statistical heterogeneity was high ( Q = 66.6, I2 = 79.4%, P < .001). On meta-regression, 77% of the heterogeneity was from studies outside the United States, where more disparity was reported (AOR, 0.29; 95% CI, 0.22-0.38).

CONCLUSIONS

Most studies continued to find decreased promotion of women. Gender disparity was particularly notable in surgery and in studies from outside the United States. The results suggest that differences in promotion were due to differences in productivity and leadership and to gender bias.

Gender based disparities in Medicare physician reimbursement persist across years and specialty

Introduction

The gender pay gap is wide in medicine but the extent of this disparity across specialties and over time have not been elucidated. Here we evaluate differences in Medicare reimbursement between men and women physicians over time and by specialty, controlling for physician and practice characteristics.

Methods

The Centers for Medicare & Medicaid Services Payment Data was used to determine total reimbursements and number of services submitted by physicians practicing in the US between 2013 and 2019. Data from the American Community Survey (ACS) were used to determine average income, unemployment rates, poverty rates, income, and educational attainment levels by zip code for each physician's practice location.

Results

Among the 3,831,504 physicians included in this analysis from 2013-2019, 2,712,545 (70.8%) were men and 1,118,859 (29.2%) were women. Overall, men received more in Medicare reimbursements ($58,815 ± $104,772 vs. $32,205 ± $60,556, p<0.001) and billed more services (864 ± 1,780 vs. 505 ± 1,007, p<0.001) compared to women. The median Medicare reimbursement for men decreased from 2013 to 2019 from $59,710 to $57,874, while the median Medicare reimbursement for women increased from $30,575 to $33,456. Men were reimbursed more than women across all specialties with the greatest disparity in procedure-heavy specialties. The specialties with the highest difference in median Medicare reimbursement between men and women were ophthalmology ($99,452), dermatology ($84,844), cardiology ($64,112), nephrology ($62,352), and pulmonary medicine ($47,399). In linear regression models controlling for calendar year, years of experience, total number of services, and ACS zip-code-level variables, men received a higher amount of Medicare reimbursement in all specialties, as compared to women (p<0.01 for all). The percentage of top earning men (range: 65.0%-99.5%) surpassed the proportion of men in each specialty (range: 46.1%-94.6%), except public health and preventive medicine.

Conclusions and Relevance

Women physicians continue to receive lower total Medicare reimbursements than men physicians, particularly in procedure-heavy specialties. Lower clinical volume and fewer procedural services among women physicians partially contribute to the disparities in reimbursement.

"Women's work": Gender and the physician workforce

Historically, the physician professional identity and the organizational structure of Western medicine have been defined by masculine norms such as authority and assertiveness. The past five decades have seen a rapid shift in the demographics of attendees as medical schools, with equal numbers of women and men matriculants for nearly twenty years. Gender as a social, cultural, and structural variable continues to influence the physician workforce. The entry of women into medicine, has had far reaching effects on the expectations of patients, the interactions of physicians with other members of the healthcare team, and the delivery of care. Redefining the culture of medicine to accommodate the diversity of the modern workforce may benefit all physician and improve the delivery of healthcare.

Mind the Gap! Working Toward Gender Equity in Pediatric and Congenital Heart Disease: Present and Future

Evidence from medicine and other fields has shown that gender diversity results in better decision making and outcomes. The incoming workforce of congenital heart specialists (especially in pediatric cardiology) appears to be more gender balanced, but past studies have shown many inequities. Gender-associated differences in leadership positions, opportunities presented for academic advancement, and recognition for academic contributions to the field persist. In addition, compensation packages remain disparate if evaluated based on gender with equivalent experience and expertise. This review explores these inequities and has suggested individual and institutional changes that could be made to recruit and retain women, monitor the climate of the institution, and identify and eliminate bias in areas like salary and promotions.

Quantifying EHR and Policy Factors Associated with the Gender Productivity Gap in Ambulatory, General Internal Medicine

BACKGROUND

The gender gap in physician compensation has persisted for decades. Little is known about how differences in use of the electronic health record (EHR) may contribute.

OBJECTIVE

To characterize how time on clinical activities, time on the EHR, and clinical productivity vary by physician gender and to identify factors associated with physician productivity.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal study included general internal medicine physicians employed by a large ambulatory practice network in the Northeastern United States from August 2018 to June 2021.

MAIN MEASURES

Monthly data on physician work relative value units (wRVUs), physician and practice characteristics, metrics of EHR use and note content, and temporal trend variables.

KEY RESULTS

The analysis included 3227 physician-months of data for 108 physicians (44% women). Compared with men physicians, women physicians generated 23.8% fewer wRVUs per month, completed 22.1% fewer visits per month, spent 4.0 more minutes/visit and 8.72 more minutes on the EHR per hour worked (all p < 0.001), and typed or dictated 36.4% more note characters per note (p = 0.006). With multivariable adjustment for physician age, practice characteristics, EHR use, and temporal trends, physician gender was no longer associated with productivity (men 4.20 vs. women 3.88 wRVUs/hour, p = 0.31). Typing/dictating fewer characters per note, relying on greater teamwork to manage orders, and spending less time on documentation were associated with higher wRVUs/hour. The 2021 E/M code change was associated with higher wRVUs/hour for all physicians: 10% higher for men physicians and 18% higher for women physicians (p < 0.001 and p = 0.009, respectively).

CONCLUSIONS

Increased team support, briefer documentation, and the 2021 E/M code change were associated with higher physician productivity. The E/M code change may have preferentially benefited women physicians by incentivizing time-intensive activities such as medical decision-making, preventive care discussion, and patient counseling that women physicians have historically spent more time performing.

Gender Differences in Medicare Practice and Payments to Neurosurgeons

Importance

Despite efforts to promote diversity within the neurosurgical workforce, individuals from underrepresented groups face significant challenges.

Objective

To compare practice metrics and earning potential between female and male neurosurgeons and investigate factors associated with gender disparity in Medicare reimbursement.

Design, Setting, and Participants

This retrospective cross-sectional study used publicly accessible Medicare data on reimbursements to female and male neurosurgeons for procedural and evaluation and management services delivered in both inpatient and outpatient settings between January 1, 2013, and December 31, 2020. Data were analyzed from December 9, 2021, to December 5, 2022.

Main Outcomes and Measures

The primary outcome was the mean annual payments received and charges submitted by female and male neurosurgeons for services rendered between 2013 and 2020. Secondary outcomes included the total number and types of services rendered each year and the number of beneficiaries treated. Univariate and multivariable analyses quantified differences in payment, practice volume, and composition.

Results

A total of 6052 neurosurgeons (5540 men [91.54%]; 512 women [8.46%]) served the Medicare fee-for-service patient population. Female neurosurgeons billed for lesser Medicare charges (mean [SE], $395 851.62 [$19 449.39] vs $766 006.80 [$11 751.66]; P < .001) and were reimbursed substantially less (mean [SE], $69 520.89 [$2701.30] vs $124 324.64 [$1467.93]; P < .001). Multivariable regression controlling for practice volume metrics revealed a persistent reimbursement gap (-$24 885.29 [95% CI, -$27 964.72 to -$21 805.85]; P < .001). Females were reimbursed $24.61 less per service than males even after matching services by code (P = .02).

Conclusions and Relevance

This study found significant gender-based variation in practice patterns and reimbursement among neurosurgeons serving the Medicare fee-for-service population. Female surgeons were reimbursed less than male surgeons when both performed the same primary procedure. Lower mean reimbursement per service may represent divergence in billing and coding practices among females and males that could be the focus of future research or educational initiatives.

The gender wage gap among health care workers across educational and occupational groups

Women perform 77% of health care jobs in the United States, but gender inequity within the health care sector harms women's compensation and advancement in health care jobs. Using data from 2003 to 2021 of the Annual Social and Economic Supplement of the Current Population Survey (CPS), we measured women's representation and the gender wage gap in health care jobs by educational level and occupational category. We found, descriptively, that women's representation in health care occupations has increased over time in occupations that require a master's or doctoral/professional degree (eg, physicians, therapists), while men's representation has increased slightly in nursing occupations (eg, registered nurses, LPNs/LVNs, aides, and assistants). The adjusted wage gap between women and men is the largest among workers in high-education health care (eg, physicians, advanced practitioners) but has decreased substantially over the last 20 years, while, descriptively, the gender wage gap has stagnated or grown larger in some lower education occupations. Our policy recommendations include gender equity reviews within health care organizations, prioritizing women managers, and realigning Medicare and Medicaid reimbursement policies to promote greater gender equity within and across health care occupations.

Women in Allergy and Immunology: The Future Is Female, Let Us Soar!

Despite increases in the number of female physicians in the past 50 years, women remain underrepresented in key areas of medicine, such as practice owners and partners, professional society leaders, principal investigators, full professors, chairs, and deans. Women are paid less, oftentimes for more work. Allergy and Immunology (AI), as a specialty, lacks substantial workforce research, but trends across specialties are consistent. We review what is currently known about women in AI and consider barriers to practice, advancement, and contribution. Through a new inquiry, we find that the challenges women in AI encounter can be summarized through 6 themes: work-life balance, professional advancement, salary equity, mentorship and sponsorship, bias, and sexual harassment and misconduct. Together, we must address these challenges head-on and provide an equitable environment for women in AI to thrive, especially those affected by intersectionality. To do so, we suggest targeted, tangible actions to promote opportunities, offer institutional support, and advance reporting and culture change outlets across AI settings.

The Future is Female: Urology Workforce Projection from 2020 to 2057

Multiple estimates have approximated a urologist shortage per capita of around 30% by 2030. In the context of the impending urologic workforce shortage, it is critical to have a nuanced understanding of the degree of workforce shortage in comparison with the US population to mitigate the negative downstream effects in the future. In continued growth and stagnant growth projection models, we found that female urologists make up a significant proportion of the workforce growth over the next four decades. This projection highlights the need for purposeful recruitment, structural changes, and advocacy among urology leadership to support and retain female urologists.

From Great Resignation to Great Retention: Orientation as a First Step in Engaging Faculty Well-being

Onboarding lays a foundation spanning multipart missions and teaches faculty how to engage and excel in the departmental environment. At the enterprise level, onboarding is a process to connect and support diverse teams, with a range of symbiotic phenotypes, into thriving departmental ecosystems. At the more personal level, onboarding involves guiding individuals with unique backgrounds, experiences, and strengths into their new roles, growing both the individual and the system. This guide will share elements of an initial step in the departmental faculty onboarding process, faculty orientation.

Gender Inequity in the Clinical Setting

Women in surgery continue to face inequitable treatment from surgical leadership, their peers, hospital staff, and even from their patients. Despite this, women surgeons continue to produce equal, or improved, clinical outcomes for their patients, with their work being given less remuneration than that of their male peers. The cultural stereotypes and biases that drive these inequities are implicit and subtle; however, they have dramatic effects on the lives and careers of women surgeons.

Workforce Attrition Among Male and Female Physicians Working in US Academic Hospitals, 2014-2019

Importance

Retaining female physicians in the academic health care workforce is necessary to serve the needs of sociodemographically diverse patient populations.

Objective

To investigate differences in rates of leaving academia between male and female physicians.

Design, Setting, and Participants

This cohort study used Care Compare data from the Centers for Medicare & Medicaid Services for all physicians who billed Medicare from teaching hospitals from March 2014 to December 2019, excluding physicians who retired during the study period. Data were analyzed from November 11, 2021, to May 24, 2022.

Exposure

Physician gender.

Main Outcome and Measures

The primary outcome was leaving academia, which was defined as not billing Medicare from a teaching hospital for more than 1 year. Multivariable logistic regression was conducted adjusting for physician characteristics and region of the country.

Results

There were 294 963 physicians analyzed (69.5% male). The overall attrition rate from academia was 34.2% after 5 years (38.3% for female physicians and 32.4% for male physicians). Female physicians had higher attrition rates than their male counterparts across every career stage (time since medical school graduation: <15 years, 40.5% vs 34.8%; 15-29 years, 36.4% vs 30.3%; ≥30 years, 38.5% vs 33.3%). On adjusted analysis, female physicians were more likely to leave academia than were their male counterparts (odds ratio, 1.25; 95% CI, 1.23-1.28).

Conclusions and Relevance

In this cohort study, female physicians were more likely to leave academia than were male physicians at all career stages. The findings suggest that diversity, equity, and inclusion efforts should address attrition issues in addition to recruiting more female physicians into academic medicine.

Closing the gender pay gap in emergency medicine: Paradigms to consider for leaders, faculty, and trainees

The gender pay gap among physicians is a well documented and persistent problem and has a profound impact on earnings over a career lifetime. This paper describes examples of concrete initiatives three institutions took to identify and address gender pay gaps. Salary audits at two academic emergency departments highlight the importance of not only ensuring equity in salary among physicians of the same rank but also monitoring whether women are achieving equal representation at higher academic ranks and leadership, elements that typically contribute to compensation. These audits reveal how senior rank and formal leadership roles are significantly associated with salary disparities. A third school of medicine-wide initiative entailed conducting comprehensive salary audits followed by review and adjustment of faculty compensation to achieve pay equity. Graduating residents and fellows seeking first jobs out of training and faculty looking to be compensated equitably would benefit from understanding the elements that drive their compensation and advocating for frameworks that are understandable and transparent.

Misconceptions about women in leadership in academic medicine

Despite progress made over the past decade, women are under-represented in positions of leadership in academic medicine. Women physicians face numerous challenges throughout their careers. Despite achieving leadership positions, women in leadership continue to experience the impact of those challenges. In this review, we describe four misconceptions about women in leadership, along with their impact and recommendations. First, we describe differences between mentorship and sponsorship, as well as their impact on attaining leadership positions. Second, the gender pay gap persists throughout women's careers, regardless of leadership positions. Third, we explore the role of self-efficacy in leadership in the context of stereotype threats. Fourth, gendered expectations of leadership characteristics place an undue burden on women, detracting from their leadership effectiveness. Organizations can address the challenges women face by creating robust mentorship and sponsorship networks, establishing transparent and equitable pay policies, promoting and normalizing a broader range of leadership styles, and improving work flexibility and support structure. Ultimately, such changes serve all members of the organization through increased retention and engagement.

Factors associated with emergency physician income

Objective

Income fairness is important, but there are limited data that describe income equity among emergency physicians. Understanding the magnitude of and factors associated with income differences may be helpful in eliminating disparities. This study analyzed the associations of demographic factors, training, practice setting, and board certification with emergency physician income.

Methods

We distributed a survey to professional members of the American College of Emergency Physicians. The survey included questions on annual income, educational background, practice characteristics, gender, age, race, ethnicity, international medical graduate status, type of medical degree (MD vs DO), completion of a subspecialty fellowship, job characteristics, and board certification. Respondents also reported annual income. We used linear regression to determine the respondent characteristics associated with reported annual income.

Results

From 45,961 members we received 3407 responses (7.4%); 2350 contained complete data for regression analysis. The mean reported annual income was $315,306 (95% confidence interval [CI], $310,649 to $319,964). The mean age of the respondents was 47.4 years, 37.4% were women, 3.2% were races underrepresented in medicine (Black, American Indian, or Alaskan Native), and 4.8% were Hispanic or Latino. On linear regression, female gender was associated with lower reported annual income; difference -$43,565, 95% CI, -$52,217 to -$34,913. Physician age, degree (MD vs DO), underrepresented racial minority status, and underrepresented ethnic minority status were not associated with annual income. Fellowship training was associated with lower income; Accreditation Council for Graduate Medical Education (ACGME) program difference -$30,048; 95% CI, -$48,183 to -$11,912, non-ACGME-program difference -$27,640, 95% CI, -$40,970 to -$14,257. Working at a for-profit institution was associated with higher income; difference $12,290, 95% CI, $3693 to $20,888. Board certification was associated with higher income; difference, $43,267, 95% CI, $30,767 to $55,767.

Conclusions

This study identified income disparities associated with gender, practice setting, fellowship completion, and American Board of Emergency Medicine or American Osteopathic Board of Emergency Medicine certification.

Interventional Pulmonology Productivity, Compensation, and Practice Benchmarks: The AABIP 2022 Report

BACKGROUND

Interventional pulmonology (IP) is a growing field that has not yet been recognized by the American Board of Medical Specialties or incorporated into national benchmark organizations. As a result, there is a lack of data on IP practice patterns, physicians' compensation and productivity targets.

METHODS

We sent an anonymous survey to 647 current or past physician members of the AABIP. Domains included demographics, training background, academic rank, practice settings, work relative value unit (wRVU) targets, salary, and career satisfaction.

RESULTS

The response rate to the survey was 28.3%; 17.8% were female. The median salary for IP faculty in academic institutions was $320,000 for assistant professors, $338,000 for associate professors, and $350,000 for full professors. Salaries were lower for women than for men in academic practice, even after adjusting for the number of years in practice (mean salary difference after adjustment $57,175, 95% CI: $19,585-$94,764, P =0.003). The median salary for private practice was higher at $428,000. Among respondents that used wRVU targets, the median targets for academic and private practice were 5500 and 6300, respectively. The majority of IP physicians are satisfied with their career choice.

CONCLUSIONS

Productivity targets in IP are used less than half the time, and when they are used, they are set in line with the lower wRVU of IP procedures. IP compensation is higher than that of general pulmonary medicine, as reported by national benchmark associations. In academic practices, gender differences in salaries were found.

Demographic Representation Among Speakers and Program Committee Members at the IDWeek Conference, 2013-2021

BACKGROUND

In 2016, the IDWeek program committee was charged with ensuring gender equity in speaker sessions. Whether this charge also resulted in more opportunities for historically underrepresented speakers is unknown.

METHODS

We conducted a retrospective analysis of trends in the demographic composition of IDWeek speakers and program committee members between 2013 and 2021. We used descriptive statistics to summarize data, χ2 tests to compare speaker demographics between 2013-2016 (before 2016) and 2017-2021 (after 2016), and Cochran-Armitage tests for trend. Each speaker slot was considered an independent event.

RESULTS

A total of 5482 speaker slots were filled by 3389 individuals from 2013 to 2021. There was a linear increase in female speakers from 38.6% in 2013 to 58.4% in 2021 (P < .001). The proportion of white speakers decreased overall from 84.9% in 2013 to 63.5% in 2021. Compared with white speakers, more slots were filled by Asian speakers after 2016 versus before 2016 (20.1% vs 14.8%, respectively; P < .001). Program committee members from 2013-2021 were >80% non-Hispanic white; <5% of committee members identified as black, American Indian, Alaska Native, Native Hawaiian, Pacific Islander, or Hispanic. More program committee slots were filled by women after 2016 than before 2016 (52.7% vs 33.9%; P = .004).

CONCLUSIONS

Intentional consideration of gender equity by the program committee was associated with equitable gender representation of invited speakers at IDWeek after 2016. Gradually, the proportions of IDWeek speakers from historically excluded racial/ethnic approached their respective proportions in the IDSA membership. White speakers remained overrepresented relative to membership proportions until 2021, and gaps in program committee racial/ethnic demographic representation highlights opportunities for continued inclusion, diversity, access, and equity at IDWeek.

Gender Homophily in Interphysician Referrals to Surgeons

INTRODUCTION

The literature on gender homophily has mostly been focused on patient-physician relationship but not on interprofessional referrals. The goal of this study is to quantify interphysician gender homophily of referring physicians in surgical referrals.

METHODS

An observational study of the referral data at a large academic center was performed. Patients referred through Epic to the department of general surgery from January 2016 to October 2019 were included. The primary end point was gender homophily and the primary independent variable was referring physician gender. Gender homophily was defined as greater than expected rates of gender concordance. Gender concordance was defined when referring physicians have the same gender as receiving surgeons. The expected concordance rate was defined as the availability of gender-concordant surgeons in the population. Absolute homophily is the difference between observed and expected concordance rates, whereas relative homophily is the ratio between observed and expected concordance rates.

RESULTS

A total of 25,271 patient referrals from 2625 referring physicians to 91 surgeons were analyzed. The overall observed concordance rate for the entire study population was 55.3% and was 31.7% among female physicians and 82.4% among male physicians. Compared to the expected concordance rate, the absolute gender homophily among all female physicians was +7.2% or a relative homophily of 1.29%. In contrast, the absolute gender homophily among all male physicians was +6.9% or a relative homophily of 1.09%.

CONCLUSIONS

Gender homophily exists in interprofessional referrals. Although referral decisions are presumably based solely on clinical factors, referrals can be affected by subjective biases.

Gender discrimination among women healthcare workers during the COVID-19 pandemic: Findings from a mixed methods study

BACKGROUND

Gender discrimination among women healthcare workers (HCWs) negatively impacts job satisfaction, mental health, and career development; however, few studies have explored how experiences of gender discrimination change during times of health system strain. Thus, we conducted a survey study to characterize gender discrimination during a time of significant health system strain, i.e., the COVID-19 pandemic.

METHODS

We used a convenience sampling approach by inviting department chairs of academic medical centers in the United States to forward our online survey to their staff in January 2021. The survey included one item assessing frequency of gender discrimination, and an open-ended question asking respondents to detail experiences of discrimination. The survey also included questions about social and work stressors, such as needing additional childcare support. We used ordinal logistic regression models to identify predictors of gender discrimination, and grounded theory to characterize themes that emerged from open-ended responses.

RESULTS

Among our sample of 716 women (mean age = 37.63 years, SD = 10.97), 521 (72.80%) were White, 102 (14.20%) Asian, 69 (9.60%) Black, 53 (7.4%) Latina, and 11 (1.50%) identified as another race. In an adjusted model that included demographic characteristics and social and work stressors as covariates, significant predictors of higher gender discrimination included younger age (OR = 0.98, 95%CI = 0.96, 0.99); greater support needs (OR = 1.26, 95%CI = 1.09,1.47); lower team cohesion (OR = 0.94, 95%CI = 0.91, 0.97); greater racial discrimination (OR = 1.07, 95%CI = 1.05,1.09); identifying as a physician (OR = 6.59, 95%CI = 3.95, 11.01), physician-in-training (i.e., residents and fellows; OR = 3.85, 95%CI = 2.27,6.52), or non-clinical worker (e.g., administrative assistants; OR = 3.08, 95%CI = 1.60,5.90), compared with nurses; and reporting the need for a lot more childcare support (OR = 1.84, 95%CI = 1.15, 2.97), compared with reporting no childcare support need. In their open-ended responses, women HCWs described seven themes: 1) belittlement by colleagues, 2) gendered workload distributions, 3) unequal opportunities for professional advancement, 4) expectations for communication, 5) objectification, 6) expectations of motherhood, and 7) mistreatment by patients.

CONCLUSIONS

Our study underscores the severity of gender discrimination among women HCWs. Hospital systems should prioritize gender equity programs that improve workplace climate during and outside of times of health system strain.

Changes in Physician Work Hours and Implications for Workforce Capacity and Work-Life Balance, 2001-2021

Importance

Physician work hours are an underexplored facet of the physician workforce that can inform policy for the rapidly changing health care labor market.

Objective

To examine trends in individual physician work hours and their contribution to clinical workforce changes over a 20-year period.

Design, Setting, and Participants

This cross-sectional study focused on active US physicians between January 2001 and December 2021 who were included in the Current Population Survey. Outcomes for physicians, advanced practice professionals (APPs), and nonphysician holders of doctoral degrees were compared, and generalized linear models were used to estimate differences in time trends for weekly work hours across subgroups.

Main Outcomes and Measures

Physician and APP workforce size, defined as the number of active clinicians, 3-year moving averages of weekly work hours by individual physicians, and weekly hours contributed by the physician and APP workforce per 100 000 US residents.

Results

A total of 87 297 monthly surveys of physicians from 17 599 unique households were included in the analysis. The number of active physicians grew 32.9% from 2001 to 2021, peaking in 2019 at 989 684, then falling 6.7% to 923 419 by 2021, with disproportionate loss of physicians in rural areas. Average weekly work hours for individual physicians declined by 7.6% (95% CI, -9.1% to -6.1%), from 52.6 to 48.6 hours per week from 2001 to 2021. The downward trend was driven by decreasing hours among male physicians, particularly fathers (11.9% decline in work hours), rural physicians (-9.7%), and physicians aged 45 to 54 years (-9.8%). Physician mothers were the only examined subgroup to experience a statistically significant increase in work hours (3.0%). Total weekly hours contributed by the physician workforce per 10 000 US residents increased by 7.0%, from 13 006 hours in 2001 to 2003 to 13 920 hours in 2019 to 2021, compared with 16.6% growth in the US population over that time period. Weekly hours contributed by the APP workforce per 100 000 US residents grew 71.2% from 2010 through 2012 to 2019 through 2021.

Conclusions and Relevance

This cross-sectional study showed that physician work hours consistently declined in the past 20 years, such that physician workforce hours per capita lagged behind US population growth. This trend was offset by rapid growth in hours contributed by the APP workforce. The gap in physician work hours between men and women narrowed considerably, with diverging potential implications for gender equity. Increasing physician retirement combined with a drop in active physicians during the COVID-19 pandemic may further slow growth in physician workforce hours per capita in the US.

The impact of virtual negotiation training for female faculty

Purpose

We developed a virtual interactive course for female faculty/practicing physicians and trainees to hone their skills in negotiation and sought to evaluate the impact of this on their knowledge, comfort, and skill in negotiation.

Methods

We surveyed participants as to their comfort and experience with negotiation before and after the course, as well as three months later.

Results

Of the 102 participants in the faculty course, 55 (53.9%) were academic ladder faculty, and 47 (46.1%) were in surgery or a surgical subspecialty. Participants were significantly more comfortable with negotiation initiation, strategy, and post-settlement settlement after the course (p < 0.001 for each). 91.1% found the course valuable, 92.9% felt their knowledge about negotiation increased, and 85.7% wished they would have taken this course earlier. 98.2% stated they were likely to use some of the things they learned in this course in future. Three months later, 40.7% of respondents stated they had used what they had learned: 57.7, 41.7, and 32.0% had negotiated for pay, promotion, or job-related perks, respectively. These negotiations went "better than expected" in 26.6, 30, and 37.5%, respectively. Prior to the course, only 3 (2.9%) felt that their last negotiation went "very well" or better; three months after the course, 28% felt their last negotiation after the course went "very well" or "extremely well" (p = 0.002).

Conclusion

Negotiation training can have a significant impact on female physicians' comfort in initiating negotiation, negotiation strategy and post-settlement discussions. Such training significantly increases "better than expected" negotiations.

Leadership Inequity, Burnout, and Lower Engagement of Women in Medicine

Gender parity has been reached in graduation rates from medical school, yet women in medicine continue to face obstacles in promotion, compensation and opportunities, leading to leadership inequity, higher burnout and lower engagement. These complex issues with gender are just one aspect of the wide challenges related to diversity, equity and inclusion among medical professionals. While there are no "one size fits all" approaches, psychologists are well positioned to lead efforts related to promoting leadership equity, reducing burnout and raising engagement because of their training in communication skills, programmatic development and empathetic listening. This paper details several evidence-based efforts in which psychologists can lead in these ongoing issues for women in medicine.

Gender Representation Among United States Medical Board Leadership

Objective: To assess the gender composition of the American Board of Medical Specialties' (ABMS) member boards and evaluate the equitable inclusion of women and a subset of women physicians. Methods: The gender of individuals on 24 boards as of March 1, 2022, was assessed. Two benchmarks-parity (50:50 representation) and equity (compared to the proportion of practicing physicians in each medical specialty)-were utilized to determine if women are equitably represented on medical boards. Results: Four hundred forty individuals hold 449 total positions on the boards examined. Of board the members, 60.7% (267/440) are men, and 92.3% (406/440) are physicians. Physician board members comprised more men (64.0%, 260/406; p < 0.001), whereas more women comprise the 34 nonphysician board members (79.4%, 27/34; p < 0.001). Using specialty representation (equity) as the benchmark, of 22 specialties for which physician gender/sex data are available, women physicians are underrepresented on 36.4% (8/22) of boards. When parity (50%) is the comparator, 72.0% (18/25) of boards comprised less than 50% women. Compared to a 2016 analysis, the proportion of women overall (including non-physicians) increased on 68.0% (17/25), decreased on 24.0% (6/25), and remained unchanged on 8.0% (2/25) of boards in 2022. Conclusions: This study reveals mixed results in the equitable inclusion of women on ABMS boards. Our findings suggest that progress should not be assumed and that it may be subject to setbacks when it occurs. There is a need to continue to monitor the equitable inclusion of women on ABMS boards.

Gender differences in paediatric hospital chief executive officer compensation

Though there is a well-established gender pay gap in medicine, studies on compensation disparities between women and men chief executive officers (CEO) showed mixed results. We conducted a cross-sectional study of children's hospitals in the USA to evaluate whether CEO gender was associated with compensation differences. Nine out of 31 children's hospitals employed a female CEO. There was no significant difference between men and women CEOs in terms of hospital characteristics (location, size or ranking in US News and World report) or CEO characteristics (advanced degrees, tenure or compensation). Gender was not associated with significant differences in CEO compensation.

Promoting Progress and Learning from Mistakes: Results of a Radiology Department LGBTQ Inclusion Audit

RATIONALE AND OBJECTIVES

As radiology programs seek to recruit and retain diverse and competitive applicants, it is important to critically review existing department policies to ensure they meet the needs of their residents. To evaluate a radiology program's inclusivity measures, an interdepartmental committee developed an "LGBTQ inclusion index" and performed an LGBTQ inclusion audit to identify gaps in policy and to craft proposals for administrative review.

MATERIALS AND METHODS

An LGBTQ inclusion index was compiled through the collaboration of an interdisciplinary committee of residents, faculty, institutional and community representatives. Five inclusion milestones were identified relating to department policy, department facilities, institutional culture, department culture, and community engagement. Milestones were scored as 0, for milestone not at all met, 1, for milestone partially met, and 2, for milestone completely met, with a total score of 10. Program scores were calculated for the 2018-2021 academic years.

RESULTS

The radiology program LGBTQ inclusion index score increased over the course of the study period. The program LGBTQ inclusion index score was 4 of 10 in 2018 and 2019, but after formation of an LGBTQ inclusion task force by the diversity and inclusion committee, increased to 7 of 10 in 2020. The LGBTQ inclusion audit identified several areas that required improvement and the committee drafted proposals to address these gaps. By 2021, the program scored 9 of 10 on the inclusion index.

CONCLUSION

Promoting an inclusive and affirming radiology department is an important step to providing culturally competent healthcare and mitigating health disparities. An LGBTQ inclusion audit and a robust department diversity committee can help to identify and address gaps in policy, facilities, and culture.

Consequences of inequity in the neurosurgical workforce: Lessons from traumatic brain injury

Women and minorities leave or fail to advance in the neurosurgical workforce more frequently than white men at all levels from residency to academia. The consequences of this inequity are most profound in fields such as traumatic brain injury (TBI), which lacks objective measures. We evaluated published articles on TBI clinical research and found that TBI primary investigators or corresponding authors were 86·5% White and 59·5% male. First authors from the resulting publications were 92.6% white. Most study participants were male (68%). 64·4% of NIH-funded TBI clinical trials did not report or recruit any black subjects and this number was even higher for other races and the Hispanic ethnicity. We propose several measures for mitigation of the consequences of the inequitable workforce in traumatic brain injury that could potentially contribute to more equitable outcomes. The most immediately feasible of these is validation and establishment of objective measures for triage and prognostication that are less susceptible to bias than current protocols. We call for incorporation of gender and race neutral metrics for TBI evaluation to standardize classification of injury. We offer insights into how socioeconomic factors contribute to increased death rates from women and minority groups. We propose the need to study how these disparities are caused by unfair health insurance reimbursement practices. Surgical and clinical research inequities have dire consequences, and until those inequities can be corrected, mitigation of those consequences requires system wide change.

Gender equality in the 21st century: Overcoming barriers to women's leadership in global health

PURPOSE

The purpose of this manuscript is to provide an overview of the significant role that women play in providing global health care, barriers encountered to achieving gender equality in global health leadership, and to propose key recommendations for advancing gender equality in global health decision-making through the integration of gender mainstreaming, gender-based analysis, and gender transformative leadership (GTL) approaches.

METHOD

Data were evaluated to determine the participation rate of women in global health care and social sector roles in comparison to men. Gender equality data from the United Nations, World Health Organization, Organization for Economic Co-operation and Development, International Labour Organization, and other resources were analyzed to assess the impact of the coronavirus disease 2019 pandemic on gender equality with an emphasis on women in global health leadership positions, the health care and social sector, and gender equality measures for girls and women throughout the world. The literature was examined to identify persistent barriers to gender equality in global health leadership positions. Additionally, a review of the literature was conducted to identify key strategies and recommendations for achieving gender equality in global health decision-making; integrating gender mainstreaming; conducting gender-based analysis; and adopting GTL programs, incentives, and policies to advance gender equality in global health organizations.

FINDINGS

Women represent 70% of the health and social care sector global workforce but only 25% of senior global health leadership roles. Since 2018, there has been a lack of meaningful change in the gender equality policy arenas at global health organizations that has led to significant increases in women serving in global leadership decision-making senior positions. During the pandemic in 2020, there were nearly 100 open vacancies-one-quarter of CEO and board chair positions-at global health organizations, but none were filled by women. Women disproportionately provide caregiving and unpaid care work, and the pandemic has increased this burden with women spending 15 hours a week more on domestic labor than men. A lack of uniform, state-sponsored paid parental leave and support for childcare, eldercare, and caregiving, which is overwhelmingly assumed by women, serve as major barriers to gender parity in global health leadership and the career advancement of women.

CONCLUSION

The pandemic has adversely impacted women in global health care and social sector roles. During the pandemic, there has been a widening of the gender pay gap, a lack of gains for women in global health leadership positions, an increase in caregiving responsibilities for women, and more women and girls have been pushed back into extreme poverty than men and boys. Globally, there is still resistance to women serving in senior leadership roles, and social and cultural norms, gender stereotypes, and restrictions on women's rights are deeply intertwined with barriers that reinforce gender inequality in global health leadership. To ensure comprehensive human rights and that equitable workforce opportunities are available, the concept of gender equality must be expanded within the global health community to consistently include not only women and girls and men and boys, but also persons who identify as nonbinary and gender nonconforming. Efforts to eliminate remnants of systemic and structural gender discrimination must also incorporate gender mainstreaming, gender-based analysis, and gender transformative approaches to achieve gender equality throughout global health systems and organizations.

How the Gender Wage Gap for Primary Care Physicians Differs by Compensation Approach : A Microsimulation Study

BACKGROUND

The physician gender wage gap may be due, in part, to productivity-based compensation models that undervalue female practice patterns.

OBJECTIVE

To determine how primary care physician (PCP) compensation by gender differs when applying existing productivity-based and alternative compensation models.

DESIGN

Microsimulation.

SETTING

2016 to 2019 national clinical registry of 1222 primary care practices.

PARTICIPANTS

Male and female PCPs matched on specialty, years since medical school graduation, practice site, and sessions worked.

MEASUREMENTS

Net annual, full-time-equivalent compensation for male versus female PCPs, under productivity-based fee-for-service, panel size-based capitation without or with risk adjustment, and hybrid payment models. Microsimulation inputs included patient and visit characteristics and overhead expenses.

RESULTS

Among 1435 matched male (n = 881) and female (n = 554) PCPs, female PCP panels included patients who were, on average, younger, had lower diagnosis-based risk scores, were more often female, and were more often uninsured or insured by Medicaid rather than by Medicare. Under productivity-based payment, female PCPs earned a median of $58 829 (interquartile range [IQR], $39 553 to $120 353; 21%) less than male PCPs. This gap was similar under capitation ($58 723 [IQR, $42 141 to $140 192]). It was larger under capitation risk-adjusted for age alone ($74 695 [IQR, $42 884 to $152 423]), for diagnosis-based scores alone ($114 792 [IQR, $49 080 to $215 326] and $89 974 [IQR, $26 175 to $173 760]), and for age-, sex-, and diagnosis-based scores ($83 438 [IQR, $28 927 to $129 414] and $66 195 [IQR, $11 899 to $96 566]). The gap was smaller and nonsignificant under capitation risk-adjusted for age and sex ($36 631 [IQR, $12 743 to $73 898]).

LIMITATION

Panel attribution based on office visits.

CONCLUSION

The gender wage gap varied by compensation model, with capitation risk-adjusted for patient age and sex resulting in a smaller gap. Future models might better align with primary care effort and outcomes.

PRIMARY FUNDING SOURCE

None.

Temporal and geographical trends in women operators of electrophysiology procedures in the United States

BACKGROUND

Cardiac electrophysiology (EP) has few women physicians.

OBJECTIVE

The purpose of this study was to determine temporal and geographical trends in the proportion of women EP operators in the United States.

METHODS

We extracted data from the Medicare Provider Utilization and Payment Database from 2013 to 2019 using procedure codes for atrial fibrillation (AF) ablation, supraventricular tachycardia/atrial flutter (SVT/AFL) ablation, and cardiac device implantation. The Medicare Provider Utilization and Payment Database excludes operators who perform ≤10 procedures annually for a given individual procedure code. The proportion of women operators was compared across the 7-year period.

RESULTS

On average annually between 2013 and 2019, 5% (n = 187) of the 3524 EP operators were women. Procedure-specific analyses demonstrated a similarly low proportion of women EP operators across each procedure type. Despite a 137% increase in the total number of AF ablationists over the 7-year period, the proportion of women remained unchanged (P = .3966). The number of SVT/AFL ablationists and device operators remained constant over time as did the proportion of women operators (P = .9709 and .3583, respectively). In 2019, 10 states (20%) had no women EP operators who performed >10 of any given EP procedure annually, 20 states (39%) had no women who performed >10 of either AF or SVT/AFL ablation procedures annually, and 10 states (20%) had no women device operators who performed >10 of any given type of device implantation annually.

CONCLUSION

Women EP operators remain underrepresented, and the proportion of women is stagnant even in areas of major clinical growth such as AF ablation. One-fifth of states had no women operators who performed >10 of any given EP procedure annually.

Diversity of leadership in academic emergency medicine: Are we making progress?

BACKGROUND

Faculty who identify as women or racial/ethnic groups underrepresented in medicine (URiM) are less likely to occupy senior leadership positions or be promoted. Recent attention has focused on interventions to decrease this gap; thus, we aim to evaluate changes in leadership and academic promotion for these populations over time.

METHODS

Successive cross-sectional observational study of six years (2015 to 2020) of data from the Academy of Administrators/Association of Academic Chairs of Emergency Medicine- Benchmark Survey. Primary analyses focused on gender/URiM differences in leadership roles and academic rank. Secondary analysis focused on disparities during the first 10 years of practice. Statistical modeling was conducted to address the primary aim of assessing differences in gender/URiM representation in EM leadership roles/rank over time.

RESULTS

12,967 responses were included (4589 women, 8378 men). Women had less median years as faculty (7 vs 11). Women and URiM were less likely to hold a leadership role and had lower academic rank with no change over the study period. More women were consistently in the early career cohort (within 10 years or less as faculty) : 2015 =-75.0% [95% CI:± 3.8%] v 61.4% [95% CI:± 3.0%]; 2020 =-75.1% [95% CI: ± 2.9%] v 63.3%, [95% CI:: ± 2.5%]. Men were significantly more likely to have any leadership role compared to women in 2015 and 2020 (2015 = 54.3% [95% CI: ± 3.1%] v 44.8%, [95% CI: ± 4.3%]; 2020 = 43.1% [95% CI:± 2.5%] v 34.8 [95% CI:± 3.1%]). Higher academic rank (associate/professor) was significantly more frequent among early career men than women in 2015 (21.1% [95% CI:± 2.58%] v 12.9%; [95% CI:± 3.0%]) and 2020 (23.1% [95% CI:± 2.2%] v 17.4%; [95% CI:± 2.5%]).

CONCLUSIONS

Disparities in women and URiM faculty leadership and academic rank persist, with no change over a six-year time span. Men early career faculty are more likely to hold leadership positions and be promoted to higher academic rank, suggesting early career inequities must be a target for future interventions.

Addressing Gender-Based Disparities in Earning Potential in Academic Medicine

IMPORTANCE

Gender-based disparities in compensation in academic medicine are recognized, but their estimated impacts on early career earning potential and strategies to mitigate them have not been well studied.

OBJECTIVES

To compare earning potential between female and male academic physicians in the first 10 years of posttraining employment and to evaluate the estimated impact of promotion timing, starting salary, and salary growth rate on earning potential.

DESIGN, SETTING, AND PARTICIPANTS

Using publicly available mean debt and compensation data for full-time employed academic physicians in the US from 2019 to 2020, starting salary, salary in year 10 of employment, annual salary growth rate, and overall earning potential in the first 10 years of employment were estimated for each gender by subspecialty. The estimated impacts of promotion timing and potential interventions, including equalizing starting salaries and annual salary growth rates, were modeled. Data analysis was performed from March to May 2021.

EXPOSURES

Gender and subspecialty.

MAIN OUTCOMES AND MEASURES

Starting salary, annual salary growth rate, year-10 salary, and earning potential in first 10 years of employment.

RESULTS

This cross-sectional study included compensation data from 24 593 female and 29 886 male academic physicians across 45 subspecialties. Women had lower starting salaries in 42 of 45 subspecialties (93%), year-10 salaries in 43 of 45 subspecialties (96%), mean annual salary growth rates in 22 of 45 subspecialties (49%), and earning potential in 43 of 45 subspecialties (96%) (median [IQR], $214 440 [$130 423-$384 954], or 10%, less). A 1-year delay in promotion from assistant to associate professor reduced women's earning potential by a median (IQR) of $26 042 ($19 672-$35 671), but failure to be promoted at all reduced it by a median (IQR) of $218 724 ($176 317-$284 466). Equalizing starting salaries could increase women's earning potential by a median (IQR) of $250 075 ($161 299-$381 799) in the subspecialties for which starting salaries for women were lower than those for men. Equalizing annual salary growth rates could increase women's earning potential by a median (IQR) of $53 661 ($24 258-$102 892) in the subspecialties for which mean annual salary growth rates were lower for women than for men.

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that gender-based disparities in starting salary and early career earning potential are pervasive in academic medicine in the US. Equalizing starting salaries would address the majority of the differences in earning potential.