Gender pay gap persists in internal medicine, especially in procedural subspecialties

Women in academic medicine are paid less than men, even when they have the same faculty rank, a recent study found.

Researchers gathered data on academic physician salaries from the 2018 to 2019 Association of American Medical Colleges Faculty Salary Report to identify gender gaps in salary and representation in academic internal medicine specialties in the U.S. Results were published as a research letter by JAMA Internal Medicine on July 12.

Women comprised less than half of full-time faculty at all ranks but were closer to equal at lower ranks of instructor (47%) or assistant (46%) than higher ranks of associate (39%), professor (24%), or chief (26%). Most faculty were women in general internal medicine, endocrinology, and geriatrics. Procedural subspecialties had fewer female faculty, with cardiology being the lowest at 21% women. Women's median annual salary was lower across all faculty ranks. Women were paid at least 90% of men's median annual salary in 10 of 13 internal medicine subspecialties; however, men's salaries exceeded women's in 90% of rank/specialty categories.

The study authors noted that salary differences between men and women in academic internal medicine appear to have improved over time but that “substantial salary inequities persist at the highest faculty levels and specifically in procedural-based specialties.” They called for additional efforts to assess and address disparities in pay and representation, especially in procedural subspecialties.

An accompanying editorial made the same point. “The issues that drive women to shun male-dominated procedural-based fields—including lack of role models, macho ‘cowboy’ culture, unpredictable schedules, longer training periods, or cultural factors—need efforts to address barriers, break down myths, and change culture,” the authors said. They also suggested removing “the premium currently paid for procedures over evaluation and management services.”

An accompanying viewpoint described the structural barriers to promotion for female junior faculty going from assistant to associate professor and discussed “how institutions can rethink promotion and reverse harms that were precipitated by the COVID-19 pandemic to promote gender equity leading.”