Women in Otolaryngology: Why Residents Should Think About Gender Inequality
Elizabeth A. Dunham, MD, MPH, PGY-5, West Virginia University “Are you my nurse?” “You little girls are surgeons?” “Are you a crier?” These are actual questions that my female colleagues and I have been asked by superiors, peers, and patients. Most current female residents and medical students I know give these stories and comments a wry smile and shake of the head. They are dismissed by many current residents as the lingering death spasms of a different era and a culture of gender inequality and male dominance in surgery. More women are entering medical school than ever before. Women now comprise about 20 percent of otolaryngologists. About a third of last year’s applicants to my residency program were women, and indeed, one of our three interns is female. In a world where almost 50 percent of current medical students are women and the presence of women in surgical subspecialties continues to increase dramatically, many graduating medical students may feel as if their gender is no longer an issue in their future career. Not so long ago women were paid differently based exclusively on gender. My mentor throughout medical school, a pediatric anesthesiologist, trained in the late 1960s and early 1970s in Texas. At that time, her husband, also an anesthesiologist, earned significantly more than she did, since as a man he was the “head of the household.” This was true for all the men in her department who were paid more for the same work. When her husband died suddenly, she asked for a raise so that now as head of the household and single mother of two young children she would earn a salary commensurate to her male colleagues. They denied her request, so she quit her job and joined a private practice, resulting in a substantial pay raise. This story shocked me as a medical student, and made me appreciate how far women have come in terms of job equality. I also was inspired by my mentor’s courage in confronting the unfairness of the system and venturing out on her own with great success. Surely this kind of blatant gender discrimination does not exist anymore, right? Is gender inequality something women in residency programs should even worry about anymore? The answer is yes—nearly $17,000 says yes, women should keep an eye out for gender issues. A recent study of starting salaries of graduating residents, even adjusting for hours worked per week and specialty, demonstrated a $16,819 pay gap between male and female starting physicians, with the men making more.1 No clear explanation was present, though issues such as women taking a lower paying job for other non-salary benefits was suggested. It is unclear if this is a more subtle form of gender discrimination, a tendency to choose lifestyle choice over salary in women, or a lack of negotiating skill. Females have been shown to underrate their skills and knowledge in self-assessment studies of medical students.2 Other studies have shown women physicians spend more time on domestic chores and childcare than their male counterparts3, perhaps leading them to select a job with more flexibility, but a lower salary. These possibilities were not fully explored in the published study showing the nearly $17,000 income disparity. Gender inequality in residency is not an issue of salary. Resident salaries are published and standardized based on PGY (post-graduate year) level at their given institution. All graduating residents are likely ill prepared to negotiate contracts and to consider the business aspects of medicine; it seems that women are especially at risk to earn less money for the same work. In preparation for future job contract negotiation, residents, especially females, should consider attending negotiation seminars offered at annual meetings. With this new data in mind, I also intend to be more assertive in negotiating a future salary when the time comes. Female residents should consider asking how offers for an initial starting salary compare to colleagues’ salaries, male and female. A universal rule of salary negotiation includes researching regional salaries within your field and institution. Yet another consideration: Are these “non-salary” benefits, such as flexible scheduling or onsite childcare, truly worth a lower salary, or are physicians who request a better “work-life balance” being taken advantage of financially? Possibly, with the help of the WIO Section, these questions can be investigated. References Lo Sasso, AT, Richards MR, Chou C-F, Gerber, SE. The $16,819 Pay Gap for Newly Trained Physicians: The Unexplained Trend of Men Earning More Than Women. Health Affairs. 2011;30(2):193. Wynn R, Rosenfeld RM, Lucente FE. Satisfaction and Gender Issues in Otolaryngology Residency. Otolaryngol Head Neck Surg. 2005; 132(6):823-7. Grandis JR, Gooding WE, Zamboni BA, Wagener MM, Drenning SD, Miller L, Doyle KJ, Mackinnon SE, Wagner RL. The Gender Gap in a Surgical Subspecialty: Analysis of Career and Lifestyle Factors. Arch Otolaryngol Head Neck Surg. 2004; 130(6):695-702.
Elizabeth A. Dunham, MD, MPH,
PGY-5, West Virginia University
“Are you my nurse?” “You little girls are surgeons?” “Are you a crier?”
These are actual questions that my female colleagues and I have been asked by superiors, peers, and patients. Most current female residents and medical students I know give these stories and comments a wry smile and shake of the head. They are dismissed by many current residents as the lingering death spasms of a different era and a culture of gender inequality and male dominance in surgery. More women are entering medical school than ever before. Women now comprise about 20 percent of otolaryngologists. About a third of last year’s applicants to my residency program were women, and indeed, one of our three interns is female. In a world where almost 50 percent of current medical students are women and the presence of women in surgical subspecialties continues to increase dramatically, many graduating medical students may feel as if their gender is no longer an issue in their future career.
Not so long ago women were paid differently based exclusively on gender. My mentor throughout medical school, a pediatric anesthesiologist, trained in the late 1960s and early 1970s in Texas. At that time, her husband, also an anesthesiologist, earned significantly more than she did, since as a man he was the “head of the household.” This was true for all the men in her department who were paid more for the same work. When her husband died suddenly, she asked for a raise so that now as head of the household and single mother of two young children she would earn a salary commensurate to her male colleagues. They denied her request, so she quit her job and joined a private practice, resulting in a substantial pay raise.
This story shocked me as a medical student, and made me appreciate how far women have come in terms of job equality. I also was inspired by my mentor’s courage in confronting the unfairness of the system and venturing out on her own with great success. Surely this kind of blatant gender discrimination does not exist anymore, right? Is gender inequality something women in residency programs should even worry about anymore?
The answer is yes—nearly $17,000 says yes, women should keep an eye out for gender issues. A recent study of starting salaries of graduating residents, even adjusting for hours worked per week and specialty, demonstrated a $16,819 pay gap between male and female starting physicians, with the men making more.1 No clear explanation was present, though issues such as women taking a lower paying job for other non-salary benefits was suggested. It is unclear if this is a more subtle form of gender discrimination, a tendency to choose lifestyle choice over salary in women, or a lack of negotiating skill. Females have been shown to underrate their skills and knowledge in self-assessment studies of medical students.2 Other studies have shown women physicians spend more time on domestic chores and childcare than their male counterparts3, perhaps leading them to select a job with more flexibility, but a lower salary. These possibilities were not fully explored in the published study showing the nearly $17,000 income disparity.
Gender inequality in residency is not an issue of salary. Resident salaries are published and standardized based on PGY (post-graduate year) level at their given institution. All graduating residents are likely ill prepared to negotiate contracts and to consider the business aspects of medicine; it seems that women are especially at risk to earn less money for the same work. In preparation for future job contract negotiation, residents, especially females, should consider attending negotiation seminars offered at annual meetings. With this new data in mind, I also intend to be more assertive in negotiating a future salary when the time comes. Female residents should consider asking how offers for an initial starting salary compare to colleagues’ salaries, male and female. A universal rule of salary negotiation includes researching regional salaries within your field and institution. Yet another consideration: Are these “non-salary” benefits, such as flexible scheduling or onsite childcare, truly worth a lower salary, or are physicians who request a better “work-life balance” being taken advantage of financially? Possibly, with the help of the WIO Section, these questions can be investigated.
References
- Lo Sasso, AT, Richards MR, Chou C-F, Gerber, SE. The $16,819 Pay Gap for Newly Trained Physicians: The Unexplained Trend of Men Earning More Than Women. Health Affairs. 2011;30(2):193.
- Wynn R, Rosenfeld RM, Lucente FE. Satisfaction and Gender Issues in Otolaryngology Residency. Otolaryngol Head Neck Surg. 2005; 132(6):823-7.
- Grandis JR, Gooding WE, Zamboni BA, Wagener MM, Drenning SD, Miller L, Doyle KJ, Mackinnon SE, Wagner RL. The Gender Gap in a Surgical Subspecialty: Analysis of Career and Lifestyle Factors. Arch Otolaryngol Head Neck Surg. 2004; 130(6):695-702.