Each year, national reports on physician compensation confirm the persistence of the gender pay gap in medicine. Across all regions and within virtually every specialty, female physicians continue to earn less than their male counterparts. According the 2018 Medscape Physician Compensation report, male doctors netted nearly 18% more income than female doctors. For specialists, the differential is even bigger, with male specialists earning 36% more than women in the same roles.
Despite enduring myths that attempt to justify the gender gap by attributing it to differences in career choice, hard work, and ambition between male and female doctors, the evidence points to a different cause. Similar to other fields, the gender pay gap in medicine is largely driven by implicit biases, gendered double-standards, and lack of transparency surrounding compensation. Many female doctors are aware of these widespread inequities, but are still left wondering how to best advocate for their own fair compensation.
Whether starting out a career, looking to change jobs, or seeking a raise in a current position, there are several steps that female physicians can take to ensure they earn the same as their male colleagues.
If you’re starting a new position
Always negotiate an initial salary offer
Whether you’re beginning your career as an attending physician or looking to change positions, contract negotiation is a pivotal opportunity for female doctors to proactively advocate for fair compensation. Contract negotiation is rarely discussed during training, so many young physicians are unsure if negotiating is even appropriate when they receive their first job offers. However, the advice from experts is unanimous: It is normal, professional, and expected to negotiate an employment contract. Physicians who ask for a higher salary are more likely to end up with a higher salary. Even in the event that an employer declines your request, asking for higher compensation seldom puts a job offer in jeopardy.
When a doctor accepts a relatively low-paying contract offer, it can depress her income for years to come. Alternatively, when a physician negotiates for a higher starting salary, she will continue to reap the benefits since future raises and salary offers could be lowered due to the initial offer amount. For example, if you can negotiate for an additional $15,000 on a salary offer, the value of that increase can compound to more than six figures over the course of your career.
Unfortunately, women tend to enter negotiations at a disadvantage. Across all fields, only 30% of women negotiate salary offers compared to 46% of men. Women experience social pressure be conciliatory in situations of negotiation and conflict, and many female physicians are aware that they are more likely than their male colleagues to be perceived as difficult or aggressive when they do negotiate. Despite working against these implicit biases, it is critical for female doctors to ask for competitive compensation. An effective contract negotiation can even help a physician establish herself as a savvy and diplomatic professional.
Do your research, know your value
Preparation is key to any successful negotiation. Equip yourself with detailed and accurate information about the standard salary range for a position. There are a variety of ways you can learn about the average salary for various specialties across different locations, but to benefit from the most accurate, specific information on physician compensation, consult with a physician-specific financial advisor.
Our team of wealth management professionals has access to the most meaningful resources on physician salaries that account for various levels of production, geographic location, subspecialties, and more. In addition to this information (which would otherwise cost an individual thousands of dollars to access), we can offer physicians insight using the database of over 6,000 contracts we’ve reviewed and negotiated in the last decade. However you choose to gather your research, be wary of cursory online search tools: sites such as Payscale, Glassdoor, or Salary.com do not factor subspecialities, regional differences, or varying leadership experience to their salary estimates. As a result, these figures are usually too generalized to be useful in negotiations.
Once you have identified the standard salary range for someone of your experience working in your speciality/subspecialty and region, you can identify a starting point for negotiations. In many cases, employers will give an initial salary offer that is 20% below what they are actually willing to pay, allowing room for negotiation regardless of whether you ask for more money.
Related: What a Physician Should Do If They Just Started a Job and Got Another Offer
Invest in professional contract review services
While research is a key starting point to help female physicians identify their market value and negotiate fair salaries, professional contract review services are the best way to ensure an employment offer is equitable and competitive from both a financial and legal standpoint. A physician-specific contract attorney and financial advisor should review your contract thoroughly before you accept any offer. This step is especially important for women physicians who may be more likely to receive a low-ball initial salary offer.
Even if an employer is unwilling to negotiate salary, there are often other areas of the contract where they may have flexibility. Depending on the position, terms such as signing bonuses, professional development support, health benefits, support staff, and lab space can all be negotiated before an employment offer is accepted. It is also possible to negotiate for financial support for medical board fees, licensing exams, and continuing education costs. These perks and extras can help female physicians boost their future earning potential. Employers can subtly add or omit a single word in a contract to their own benefit, resulting in serious implications on your work and earnings. A contract review professional will help you identify contractual red flags and offer advice about the negotiation process.
Professional contract reviews are an affordable option to help physicians secure more lucrative, favorable contracts. Oftentimes a boiler-plate employment contract will contain terms regarding bonus structure, tail-coverage, and non-compete clauses that deeply disadvantage physicians and curtail their earning ability. A professional contract review can result in an employment offer that cumulatively yield millions more in income over the course of a physician’s career.
You don’t have to talk about your current salary
Consider the following scenario: A female cardiologist accepts her first employment offer with a salary of $325,000 without negotiating for higher compensation. Several months into her job, she learns she is making $25,000 less annually than a colleague in a similar role. A few years later, she decides to search for another position, in part because she wants to earn more money to pay back her loans faster. As she interviews for new jobs, it’s not uncommon for prospective employers to ask: “What is your current salary?”
It’s a standard interview query, but answering this question can also influence a job offer to reinforce the gender pay cycle. In the case of our hypothetical cardiologist, she may undermine her own negotiating position by telling prospective employer her current salary (which she knows undervalues her professional worth). An employer who was prepared to offer the cardiologist a salary as high as $355,000, may lower their offer to $341,000 when they hear her current income, reasoning that she should be pleased with a 5% increase to what she presently earns.
For women, racial minorities, and other groups who are still likely to be underpaid in the medical field, when an interviewer asks, “What is your current salary?”, they might as well be asking “How little can we pay you?” When you share your salary history, one underpaying job early in your career can continue to depress your earning ability for future positions. For this reason, several states and cities have actually banned prospective employers from asking new hires about their salary history.
If you feel that your current salary is not a fair reflection of your market value, avoid answering interview questions about what you earn. It may feel a bit uncomfortable to dodge the question, but it if you can’t politely avoid the question, try to remain vague. Provide a salary range instead of a single figure, or simply say your pay structure is dependent on a number of variables and you would have to consult your tax professional for specifics.
If you want a salary increase in your current role
For female physicians who are looking for increased compensation in their current role without making a job change, there are several ways to raise the issue with your employer in a professional, direct manner.
Choose the right time to ask for a raise
Just as female physicians are less likely to negotiate initial salary offers, they are often more hesitant than their male colleagues to ask for raises. To help ease the dialogue around a salary increase, pick a strategic time such as a quarterly or semi-annual review. If your employer offers a largely positive performance review, you can leverage this feedback into a request for a raise.
Alternatively, you can time your request for a raise after a funding review or in the wake of a major professional accomplishment.
Bear in mind that your may not receive a raise until the term of your existing contract has elapsed or is renewed. To avoid waiting for a new contract to receive equitable pay, it’s crucial to have your initial job offer reviewed and negotiated by a financial advisor and lawyer.
Talk to your colleagues, ask for transparency
While salary information is always a sensitive issue to discuss among colleagues, the topic is becoming less taboo in many workplaces. Lack of transparency around employee salaries and bonuses is a major factor contributing to the gender pay gap, because many women are not even aware that their male colleagues are earning more
If you believe that you could tactfully and discreetly inquire with a few of your colleagues about their compensation, do so. When possible, it’s helpful to ask both male and female colleagues. Pairing this information with large surveys of compensation metrics can prove helpful to close the gender pay gap and help you build your case when you negotiate for a raise or a new contract
If you suspect there is a pervasive gender pay gap at your place of work, bring it up with the organization. During a contract renewal or performance review, you can ask if your company is cognizant of gender pay gaps. You can also request comparative compensation data. This may not be a comfortable conversation for your employer, but it will indicate that you are alert to the issue and will not passively accept inequitable compensation. If you wish to take matters further, you can also report suspected pay discrimination by filing a complaint with the EEOC.
Record your accomplishments, build your CV
If you’re preparing to ask for a raise, you should build a comprehensive case detailing your professional value. Maintain a careful record of your accomplishments, positive feedback from colleagues and patients, as well as your incentive scores and productivity bonus. You may also be able to inquire with accounts payable to learn how much your employer has billed and earned from your work.
When the time comes to ask for a salary increase, come prepared with the information you need to justify the value of your work. You can also use performance reviews or salary negotiations as a chance to request more responsibilities or professional development opportunities. Ask to sit on a committee or take a larger role in practice management. If you’re accepting additional professional duties, it may be appropriate to negotiate your job title as well. These steps can help you boost your profile, gain leadership experience, and build your CV– all of which will increase your future earning ability.
If your employer is not conducting regular reviews, ask for one. In the event that your employer turns down your proposed salary increase, provide them with a written copy of your goals and requests such as future salary expectations or professional development opportunities. By doing this, you can ensure the organization has a record of your requests for future reviews and negotiations. Similarly, any promises your employer makes regarding future raises, reviews, or promotions should be recorded in writing as well.
Related: What Doctors Can Expect During Physician Salary Negotiation
As the leaders in the medical field work to rectify the systemic causes behind the gender pay gap, female doctors are often tasked with extra challenges to ensure they receive equitable compensation. By working for more transparency, insisting on equity, and substantiating requests with research, female physicians can be more confident and effective as they ask employers for the salaries that they deserve.
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We want to talk about income protection, too. Read our guide to Disability Insurance for Physicians