Social media was on fire recently with medical professionals infuriated with Dr. Gary Tigges, a general internist whose survey response was featured in the “Big and Bright Ideas” section of the Dallas Medical Journal September’s “Women In Medicine” issue[1]. The journal wrote: “According to a Wall Street Journal article, salaries of women physicians are about 64 percent of their male counterpart’ salaries. We asked our physicians if they believe a pay gap exists between male and female physicians. If so, what is the cause? What steps can physicians take as individuals and as a community to address this?” Dr. Tigges acknowledged the gap and remarked that that female physicians simply “do not work as hard”. After severe backlash, Dr. Tigges told the Dallas news that he was misquoted, not knowing that the responses would be published. He also issued an apology on his webpage and subsequently resigned from his leadership roles on the medical board and credentialing committee at Texas Health Plano.
Work effort and volume productivity should not be confused; they are not the same metric. A portion of the income gap may be due to division of labor at home; in one study, women spent 8.5 more hours per week on domestic activities than their male counterparts. Furthermore, women were more likely than men to have spouses or domestic partners who were employed full-time, and in the subgroup with spouses or domestic partners who were employed full-time, the women were more likely to take time off during disruption of usual child care arrangements than men[2] [3].
But female providers have separate challenges regardless of their obligations outside of work. While career interruptions and differing time allocation between personal and professional interests can delay career advancement, evidence suggests that women providers may also have an intrinsically more challenging job. More specifically, patients tend to expect more of female physicians. Female patients tend to seek more empathic listening and longer visits, and female doctors have more female patients. Furthermore, patients of female physicians speak more during office visits and disclose more biomedical and psychosocial issues, resulting in a 10% increase in appointment duration compared to male colleagues4.
While the volume of a female physician’s practice may be in question, the quality of her practice is not. Female physicians may be more likely to adhere to clinical guidelines, provide preventive care more often, use more patient-centered communication, perform as well or better on standardized examinations, and provide more psychosocial counseling to their patients than do their male peers. Consequently, patients of female physicians appear to obtain better outcomes, with lower readmission and mortality rates in one study of Medicare patients[5].
The gender gap between male and female physicians deserves continued focus and attention to find scalable, sustainable solutions, both for our profession and our patients. While we tease out causes and solutions, one thing is for certain: UHA continues to grow robustly with 60% female providers. During September, we celebrate our female providers and welcome any and all “Bright Ideas” for discussion.
Rachel Roberts, MD
Medical Director, Provider Wellness
Bryan Bohman, MD
Chief Medical Officer, University HealthcCare Alliance
[1] http://www.dcms.branchmediapro.com/2018/09September/page_12.html
[2] Gender differences in time spent on parenting and domestic responsibilities by high- achieving young physician-researchers. Jolly, S., Griffith, K. A., DeCastro, R., Stewart, A., Ubel, P., & Jagsi, R. (2014). Annals of Internal Medicine, 160, 344–353.
[3] Fostering Resilience among Mothers under Stress: “Authentic Connections Groups” for Medical Professionals. Luthar S. Women’s Health Issues 27-3 (2017) 382–390
[4] Tsugawa Y, Jena AB, Figueroa JF, Orav J, Blumenthal DM, Jha AK. Comparison of hospital mortality and readmission rates for Medicare patients treated by male versus female physician. JAMA Intern Med. 2017;177:206–13.
[5] Tsugawa Y, Jena AB, Figueroa JF, Orav J, Blumenthal DM, Jha AK. Comparison of hospital mortality and readmission rates for Medicare patients treated by male versus female physician. JAMA Intern Med. 2017;177:206–13.