Revisiting the Gender Gap: The Growing Disparity between Female and Male Physicians from 1999 to 2008

The emergence of women in medicine has been widely documented for decades. While women physician’s salary has traditionally lagged behind that of men, the difference has frequently been “explained away” by controlling for variables such as specialty, work hours, and practice type. In more recent years, women have increasingly been leaving primary care fields and entering subspecialty fields that have historically been dominated by men. Our goal is to explore whether this change has led to great convergence over time in physician salaries by gender. We use data from the New York State Survey of Residents Completing Training conducted by the Center for Health Workforce Studies of the State University of New York at Albany over the year 1999 through 2008. We focus on graduating residents and fellows indicating that they have accepted positions in patient care/clinical practice, yielding a sample of 8,233 new physicians. We use ordinary least squares regressions to estimate the adjusted differences in salary between men and women over time, controlling for a host of observables, including practice type, hours worked, and practice location. On an unadjusted basis, we do not find that the gap between male and female physician starting salaries narrowed during the 10-year period from 1999-2008, despite the fact that the fraction of women in primary care fields dropped from nearly 50% in 1999 to 34% in 2008. The fraction of men in primary care fields stayed relatively constant over the same time period at roughly one-third. After controlling for other observable characteristics, starting salary differences between men and women were statistically insignificant in 1999 (p=.07). However, by 2008 there was a substantial unexplained difference in starting salary of nearly $17,000—close to 10% of income—between men and women (p<.001). We postulate that unobservable job factors are the impetus for this contemporary income disparity rather than overt discrimination. Whereas prior studies believed the influx of women into medicine had erased gaps in physician pay, we believe this same influx of women has actually redrawn the physician labor market in a way that has fomented a new gender income gap. Our work is particularly timely given the context health care reform and the demands on the physician workforce that millions of newly insured individuals will bring. Policy makers, physician practice groups, and medical training programs will have to reconsider how they attract providers and how they construct their working arrangements and pay in light of the continued rise of women in medicine and the new set of provider preferences that accompany this change in the gender makeup of US physicians.