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Salary Equity among Male and Female Internists
- Roberta Ness, MD, MPH; and
- Flora Ukoli, MD
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IN RESPONSE:
We appreciate Dr. Ross's comments. As with most research, our analysis leaves as many important questions unanswered as answered. In this case, the relevant questions relate to the economic, social, and cultural factors driving salary inequity.
Dr. Ross cites three factors that may have confounded our results: weeks worked per year, productivity, and voluntary lifestyle tradeoffs. Dr. Ross himself shows that number of weeks worked per year would not eliminate the observed effect. His further point about productivity was considered in a 1999 survey published by Physician's Weekly, based on a poll of physicians from the Medical Group Management Association, the United States' largest organization of physicians working in group practices (1). Although women did report seeing fewer patients per year, in part because of fewer working hours and in part because they spend more time with each patient, patient load could not account for the salary gap observed. For example, among noninvasive cardiologists, after adjustment for patients seen, men earned $163 per case and women earned $144 per case. The final issue Dr. Ross cites as a possible confounder is voluntary lifestyle tradeoffs leading to choice of subspecialty and practice type. To avoid confusion, we reiterate that even after adjustment for differences in professional niche, women were less well compensated then men. Had we not adjusted for this, the salary differential would have been far greater than the adjusted 14% we reported.
Do cultural and social factors influence decision making, and are men and women similarly influenced? Ample data suggest that women, particularly those with children, face major obstacles in career trajectory that men do not face (2, 3). For instance, even among dual-physician couples, women are more likely to report changing their schedules to accommodate child care responsibilities (4). In these couples, women more often reported limiting professional life for family reasons and men more often reported that their career had taken precedence over their spouse's. This would be fine if women made these decisions freely and contentedly. But women have been shown to experience more frustration over competing work and home life demands than men (3). Thus, the assertion that women deserve lower pay because of voluntary decisions is truly an undocumented allegation. It depends on the meaning of “voluntary.” Culturally driven? Yes. Freely and contentedly? Maybe no. Women must be asked.
Roberta Ness, MD, MPH
Flora Ukoli, MD
University of Pittsburgh; Pittsburgh, PA 15261
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
