During a 40-year career, the average female physician with children made $3 million less than the average male physician with children — nearly double the male-female earnings gap experienced by single physicians, according to a national study of 95,000 physicians.

In a cross-sectional analysis of surveys conducted from 2005 to 2019, female physicians earned as much as 24% less per hour than their male peers, regardless of whether they were single, married, or had children, reported Lucy Skinner, MPH, a fourth-year medical student at the Geisel School of Medicine at Dartmouth in Hanover, New Hampshire, and colleagues.

As pay accumulated among physicians ages 25 to 64, male-female earnings gaps reached $1.6 million for single physicians, $2.5 million for married physicians without children, and $3.1 million for married physicians with children, the group detailed in JAMA Health Forum.

Similar Results Across Family Types

Studies have shown for years that male physicians make significantly more money than their female colleagues; however, this analysis quantified those differences and drilled down to highlight gaps in earnings by marital status and family type.

“The main takeaway is that across all family structures, female physicians make less than men, and then if you add in getting married and having kids, that gap grows,” Skinner told MedPage Today.

“There is a penalty for women to get married and to have children, but we don’t see a penalty for men,” she said. And that earnings penalty is driven mostly by female physicians working fewer hours relative to their male peers.

Male physicians worked 4.4 more hours per week and tended to be self-employed more often than female physicians (24.9% vs 14.6%). Single men worked 0.6% more hours than single women; that percentage difference was 7.0% for married physicians and 17.5% for physicians with children.

On average, male physicians earned $91,000 more than female physicians after adjusting for 2019 dollars, the study authors noted, with male physicians making 21.4% to 23.9% more per hour than female physicians, regardless of family structure.

Women Choose Lower-Paying Specialties

With regard to lower per-hour pay, Skinner and her colleagues speculated that those differences could be driven by women choosing to practice in lower-paying specialties, noting that women are often steered toward those lower-paying specialties.

Female medical students may experience “benevolent sexism,” where, for example, an advisor encourages them to consider a career in pediatrics or internal medicine, because it will afford them more time to take care of children, Skinner said. Female physicians may also experience “hostile sexism” — for example, when a visibly pregnant medical resident interviews for a job and is denied that position on the basis of her pregnancy.

The “marriage penalty” is not a new phenomenon, explained Skinner. It’s something that’s been observed in many fields in which women, once they are married are paid less, while men get paid more after marriage.

There are a lot of theories around what drives this phenomenon, Skinner said, “Maybe employers view a married man as trustworthy and reliable. So they give [him] a promotion.” Whereas a married woman may be seen by an employer, who thinks, “Maybe they’re going to have a kid and take time off,” and pays them less, she said.

In addition, the authors noted that differences in earnings per hour may also stem from male physicians having a “greater willingness ” to negotiate for a higher salary and the “preferential choice of male physicians for positions of leadership.”

With regard to gaps in hours worked, “one potential reason why male physicians work more hours and shoulder a lesser burden at home may be that married male physicians may have spouses who are not working, are lower paid, and are less highly educated compared with spouses of female physicians,” noted Skinner and her coauthors.

“This paper is not trying to say that women should work more,” Skinner said, but rather that women and men should be supported with equal maternity and paternity leave.

Beyond that, institutions should support childcare “so that women are able to choose how much they want to work,” said Skinner. The researchers also encouraged institutions to investigate their own gaps in pay across sexes.

Study Methodology, Limitations

The study used data from the American Community Survey (ACS) collected from 2005 to 2019. The study sample included 95,435 physicians, of which 64.2% were male and 35.8% were female. Respondents had a mean age of 44 years, and female physicians tended to be younger than male physicians (42 vs 46 years, respectively).

Among the physicians in the sample, two-thirds were white, 20% were Asian, 6% were Hispanic, and 5% were Black. Notably, female physicians were “more likely to identify as a minoritized race or ethnicity,” at 38% versus 30% of men. Compared to male physicians, female physicians were also more likely to be single (19% vs 11%) and less likely to have children (53% vs 58%).

Limitations of the study include that physician income, when comparisons are made between ACS and tax forms, “suggest that business income is underreported in ACS,” which the authors said may actually “understate the female-male gap in earnings,” especially given that males in the sample were more likely to be self-employed.

Researchers were unable to analyze patterns by specialty, a limitation of the ACS. However, Skinner and her coauthors noted that by not adjusting for specialty their study was able to illustrate “the mediating effects of sex on specialty choice through structural sexism.” They also noted that other studies have found estimates of earnings gaps by sex among physicians persist even after adjusting for specialty and for practice characteristics.

The authors also said that the study analysis relied on self-reported hours worked, “which may be underreported for female physicians,” who they noted spend more time documenting in the electronic health record outside of business hours compared to male colleagues.

Lastly, Skinner and her coauthors acknowledged that “because most physicians spent some of their careers in more than one of these family types” — single, married, childless, or with children — “and have careers shorter than 40 years, actual earnings differences may be less than these estimates.”

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