Ah, pediatrics, Dr. J.’s worst grade in medical school…

Just as Dr. J. sent off his missive earlier today, his Medical Economics weekly email showed up in his inbox. He, of course, clicked on this lead article.

The headline states that female physicians earn $56K less than males. Well, duh.

It sites this study from JAMA Internal Medicine (formerly Archives of Internal Medicine) in which the authors troll the Current Population Study examining healthcare provider salaries, hours, age, race sex, and state of origin. All of those variables were adjusted for and there was an approximately 20% wage gap from 1987-2010.

There were a number of flaws with this study, all of which are freely discussed by the authors.

In their words:

Although we adjusted for differences in hours worked and years of experience, our study was limited because the CPS does not include data on specialty, practice type, procedural volume, and insurance mix, all of which could influence our findings. Our inability to adjust for these factors likely explainswhywe found a gender gap in earnings in 1987-1990, while a previous analysis in this period that adjusted for these factors did not.

First is that the reported income was capped at $250K. Second, as specialty data were not available, one could not adjust for the larger population of women in lower paying fields (internal medicine, pediatrics, etc.) and fewer in higher paying fields (orthopedic surgery, interventional cardiology, electrophysiology, neurosurgery, etc.). Similarly, it did not adjust for practice type, private practice, hospital owned, academic, non-academic, and the VA. Hours worked is not a sufficent surrogate for academic and VA positions where the benefits are good, and it is a working mom friendly environment, but the pay is lower than in the private setting.

Furthermore, it didn’t adjust for marital status and spousal income. Dr. J. knows a number of two doctor households. Usually the husband is the higher earner, with the wife enjoying an academic job or a position in a more child-rearing friendly field. He also knows a number of female doctors (largely academics as well) who are married to non-medical husbands that are otherwise loaded.

Those, however are not always the case. Dr. J. knows a pair of couples where the wife is the primary bread earner while one husband is getting his lab off the ground and the second is a very successful NIH funded researcher. A third case involves a female doctor whose husband is an aspiring musician and a stay-at-home dad. The second case is the husband of one of Dr. J.’s 0.8 FTE colleagues, who is still probably bringing more bank than hubs. Those, however are the exceptions.

Again, this brings Dr. J. full circle to job choice. Economic discrepancies are not a consequence of da man, but rather due to freedom of choice and opportunity costs.

Dr. J.