Organizational Culture, Practices, and Patterns of Interaction that Drive the Gender Pay Gap in Medicine: Second-Generation Gender Bias and Other Complexities

Women physicians must balance implicit social expectations to be nice, caretaking, and other-focused while carrying out the requisites of being a competent clinician, researcher, educator, and/or administrative leader. Considered “second-generation gender bias,” these cultural assumptions are not intentional or overt. However, they impact how women are evaluated, promoted, and therefore compensated in the healthcare workplace. The effects of gender-based differences in performance assessments, specialty choice, burden of domestic responsibilities, penalties for childbearing and negotiation, allocation of professional resources, sponsorship, and clinical productivity and patient satisfaction measures are cumulative across a woman’s career in medicine, resulting in inequities in advancement and compensation.