Gender Pay Gap a Problem in Pediatrics, AAP Policy Statement Says

Equity in pay should be a professional and public health imperative in pediatrics, where pervasive gender-based pay gaps impact an increasingly female pediatric workforce, a new policy statement from the American Academy of Pediatrics (AAP) said.

The organization made several recommendations to help organizations address those inequities, including metric-based compensation, family-friendly work practices, transparent career advancement pathways, and equitable attainment of leadership positions.

Other recommendations include payments rates that are at least comparable with prevailing Medicare rates, and policies that prevent discrimination and harassment, Eva Catenaccio, MD, of the Perelman School of Medicine at the University of Pennsylvania and Children’s Hospital of Philadelphia, and colleagues from the AAP’s Committee on Pediatric Workforce, Council on Health Equity, and Female Leadership and Excellence in Pediatric Subspecialties Leadership Team, wrote in the policy statement.

“As women have come to make up more and more of the physician workforce, and in particular the pediatric physician workforce, the issue of the gender pay gap has become more pressing because it impacts such a large number of pediatricians,” Catenaccio told MedPage Today. “It’s also an important issue in pediatrics because there are ongoing concerns about the ability of the pediatric healthcare workforce to meet the healthcare needs of children in this country, both now and going forward.”

Indeed, despite being a growing percentage of the physician workforce, women continue to be paid less than their male counterparts, MedPage Today previously reported. Pediatrics also has some of the lowest starting salaries of any specialty.

Within pediatrics, women across all levels, ranks, and subspecialties earn 76% to 87% of what men earn, according to the policy statement. Additionally, starting salaries for women pediatricians are a median of $10,000 lower than those for men, and after 10 years in practice, the gap widens to about $20,000.

Meanwhile, as of 2021, 65% of practicing pediatricians and 70% of graduating pediatric residents were women.

Catenaccio and colleagues pointed to varied factors that contribute to gender-based pay inequities, including a lack of mentorship, sponsorship, and coaching for women physicians; workplace discrimination; and greater caregiving responsibilities outside of work.

“Implicit bias against women physicians is prevalent throughout medical training and practice and can negatively impact career trajectories,” they wrote. “For example, women are more likely than men to be asked illegal questions about marital status or family planning during residency interviews.” And “[w]omen are often perceived as unfit for leadership roles and are penalized for exhibiting traits such as ambition or competitiveness.”

“It is such a complex problem that no one strategy can solve it,” Catenaccio told MedPage Today.

One recommendation is to establish equitable compensation “based on transparent, objective, and predetermined metrics” and to provide ongoing assessments of gender equity when it comes to pay, the policy statement said.

Secondly, they called for the implementation of women- and family-friendly workplace practices, such as paid leave for both parents, accommodations for breastfeeding, and flexible work arrangements.

Catenaccio and colleagues also urged transparent career advancement and promotion pathways, such as the availability of mentorship, sponsorship, and leadership training programs for women; inclusion of provisions in loan repayment or forgiveness programs that allow for proportional participation for part-time work; additional mentorship after return from parental leave and re-entry programs after extended parental leave; and regular evaluations of promotion eligibility among women physicians.

They further advised equitable attainment of leadership positions for women and men; advocacy for payment rates across all payers that are at least comparable to prevailing Medicare rates and support for a full range of services needed to provide comprehensive care to kids; compliance with laws and implementation of policies that prevent discrimination or harassment based on characteristics of personal identity; and workplace culture that supports the inclusion of women throughout medicine.

Catenaccio and colleagues noted that even “small differences in starting salary can lead to substantial differences in lifetime wealth accumulation.”

A study estimating accumulated wealth, including accrual of retirement savings and other salary-based investments over time, found that male medical school faculty were predicted to rake in an additional $500,000 across their career compared with female faculty, Catenaccio and colleagues wrote. The study also estimated that a woman would need to spend $0.60 in retirement compared to every $1 spent by a man to make her savings last.

Gender-based pay inequities also “influence physician workforce distribution and healthcare access for children,” Catenaccio and colleagues noted.

Lower-earning subspecialties within pediatrics — often dominated by women — have “less robust workforces,” they added, leading to longer wait times for patients and greater distances to travel. These subspecialties also are less likely to fill fellowship spots, “which further exacerbates access problems.”

“It is not within the power of an individual to solve this problem even if they do an excellent job negotiating for themselves,” Catenaccio told MedPage Today. “It is something that needs to be addressed at the level of organizations and institutions across the field using evidenced based strategies with regular reassessments.”