Salary disparities in academic urogynecology: Despite increased transparency, men still earn more than women

Abstract

Objectives:

To understand the compensation differences between male and female academic urogynecologists at public institutions.

Methods:

Urogynecologists at public universities with publicly available salary data as of June 2019 were eligible for the study. We collected characteristics including gender, additional advanced degrees, years of training, board certification, leadership roles, number of authored scientific publications, total National Institutes of Health funding and number of registered clinical trials for which the physician was a principal or co-investigator. We also collected total number of Medicare beneficiaries treated and total Medicare reimbursement as reported by the Centers for Medicare and Medicaid Services. We used linear regression to adjust for potential confounders.

Results:

We identified 85 academic urogynecologists at 29 with available salary data eligible for inclusion in the study. Males were more likely to be an associate or full professor (81%) compared with females (55%) and were more likely to serve as department chair, vice chair or division director (59%) compared with females (30%). Mean annual salary was significantly higher among males ($323,227 ± 97,338) than females ($268,990 ±72,311; p = 0.004). After adjusting for academic rank and leadership roles and years since residency, the discrepancy persisted, with females compensated on average $37,955 less annually.

Conclusions:

Salaries are higher for male than female urogynecologists, even when accounting for variables such as academic rank and leadership roles. Physician compensation is complex; the differences observed may be due to variables that are not captured in this study. Nevertheless, the magnitude of disparity found in our study warrants further critical assessment of potential biases within the field.

INTRODUCTION

While women’s earnings have improved from 59 cents to a dollar ratio in 1963, now, 56 years later, the gender wage gap persists across all employment sectors.¹ In 2017, women’s median salaries were equivalent to 80% of men’s salaries.¹ When considering confounding factors, such as time worked, occupation, and education level, inequalities in compensation remain.^2,3

The field of medicine is no stranger to gender wage disparities. Even as increasing numbers of women choose to pursue medical careers, with women now comprising the majority of medical school matriculants since 2017⁴, numerous studies have shown that female physicians and surgeons continue to earn less than their male counterparts.^5,6 According to the 2017 US Census Bureau, the ratio of female to male physician earnings was 0.71, with women earning a median salary of $171,880 compared to men earning $243,072.⁷ A 2018 survey of 65,000 full-time licensed physicians reported a gender pay gap of 27.7%, where female doctors earned on average $105,000 less than male doctors.⁸

Despite the fact that obstetrics and gynecology has a relatively high proportion of female surgeons, underrepresentation of female physicians in academic leadership roles is common⁹ and salary disparities within obstetrics and gynecology are prevalent.¹⁰ Urogynecology is a subspecialty of obstetrics and gynecology, and there is little data on gender disparities within this field. The goal of this study is to improve our understanding of the compensation differences between male and female surgeons within the field of academic urogynecology.

MATERIALS AND METHODS

Freedom of Information laws that mandate release of salary information of public university employees have been implemented in many states. These records frequently include public employee salary data, detailing the full name, title, institution, and salary of all public employees in that state. For this study, we identified states where salary data of public employees was available online as of June 2019. We identified all urogynecologists at public state universities. For each eligible physician, we collected characteristics such as gender, additional advanced degrees, years of training, board certification and leadership roles. Leadership roles were divided into administrative leadership roles, including department chair, vice chair and division director, and educational leadership roles, including fellowship director, residency director and clerkship director. Gender was determined by name and confirmed with photo and pronoun use, when available. As indicators of research productivity, we collected the number of authored scientific publications indexed in Web of Science, total National Institutes of Health (NIH) funding from the NIH Research Portfolio Online Reporting Tools (RePORTER) database and number of registered clinical trials for which the physician was a principal or co-investigator from ClinicalTrials.gov. As indicators of clinical productivity, we collected total number of Medicare beneficiaries treated, total Medicare charges and total Medicare reimbursement as reported by the Centers for Medicare and Medicaid Services. Reported salaries under $150,000 were excluded from the analysis, because we hypothesized that these individuals likely did not work full-time or earned only a portion of their income from a public institution. When data regarding part-time status was available, we used the percent effort to determine a full-time equivalent salary for that physician.

Data are presented as percent or mean ±standard deviation. We used linear regression to compare salaries between male and female urogynecologist and to assess potential confounders; we retained covariates in the model if they had an appreciable influence on the effect estimate. Covariates considered for the final model included academic rank, administrative leadership roles, educational leadership roles, years since residency and research publications. Statistical significance was assessed based on whether the confidence interval excluded the null value of 0. Study data were collected and managed using Research Electronic Data Capture (REDCap) electronic data capture tools hosted at Beth Israel Deaconess Medical Center¹⁴ and were analyzed with SAS 9.4 (SAS Institute, Cary, North Carolina).

RESULTS

We identified 85 academic urogynecologists at 29 public state academic institutions. In total, urogynecologists represented 17 states with publicly available salary data; physicians practiced primarily in California (26%) or Texas (20%). The mean years since residency was greater for males (25 ±10) than females (15 ±9), and males were more likely to be an associate or full professor (81%) compared with females (55%). Male urogynecologists also were more likely to serve as department chair, vice chair or division director (59%) than female urogynecologists (30%). Males and females were similar with regard to geographic distribution, having an educational leadership role, and being an NIH grant recipient. However, female urogynecologists were more likely to have an advanced degree and received more NIH funding compared to male urogynecologists. While female urogynecologists treated more Medicare patients than male urogynecologists, they received similar Medicare reimbursement for their services (Table 1).

Table 1:

Characteristics of faculty

	Female, n=53	Male, n=32
Geographic region
Northeast	0 (0)	0 (0)
Midwest	8 (15)	8 (25)
South	23 (43)	13 (41)
West	22 (42)	11 (34)
Years since graduation from residency	15 ±9	25 ±10
<5	2 (4)	0 (0)
5 to <10	15 (28)	1 (3)
10 to <15	11 (21)	4 (13)
≥15	25 (47)	27 (84)
Fellowship-trained	40 (75)	14 (44)
Board-certified	40 (75)	25 (78)
Advanced degree
Master’s	12 (23)	2 (6)
Doctorate	1 (2)	0 (0)
Academic rank
Assistant	24 (45)	6 (19)
Associate	12 (23)	14 (44)
Professor	17 (32)	12 (38)
Administrative leadership*
Department chair/vice chair	5 (9)	3 (9)
Division director	15 (28)	18 (56)
None	37 (70)	13 (41)
Educational leadership*
Fellowship director	8 (15)	7 (22)
Residency director	2 (4)	1 (3)
Clerkship director	3 (6)	0 (0)
None	41 (77)	24 (75)
Publications indexed in Web of Science
Total publications	11 (5 – 33)	16 (6 – 45)
First author publications	4 (2 – 11)	3 (0 – 7)
Last author publications	1 (0 – 8)	3 (1 – 12)
h index	5 (2 – 10)	8 (4 – 16)
NIH grant recipient	11 (21)	7 (22)
NIH grant value among recipients (US$)	2,871,885 (563,359 – 5,441,876 )	1,928,492 (566,717 – 4,655,966)
Medicare beneficiaries treated	179 (79 – 246)	164 (88 – 254)
Medicare charges (US$)	236,363 (60,976 – 432,076)	184,091 (68,510 – 348,081)
Medicare payments (US$)	41,838 (16,916 – 76,763)	41,432 (21,629 – 87,081)

Data are presented as n (%), mean ±standard deviation or median (interquartile range)

^*An individual can have more than one administrative or educational leadership position

Overall, the mean annual salary in our cohort was $289,409 and male urogynecologists were more likely to be overrepresented among those earning >$300,000 (Figure 1). The mean annual salary was significantly higher among male urogynecologists ($323,227 ±97,338) than female urogynecologists ($268,990 ±72,311; p = 0.004), yielding a mean difference of $54,237 and an earnings ratio of 0.84. After adjusting for academic rank, administrative leadership roles, educational leadership roles, and years since residency, this wage gap persisted, with females compensated on average $37,955 (95% CI: -$74,908, -$1,001) less annually compared with their male counterparts. Further adjusting for academic productivity, including research publications, did not appreciably affect the salary discrepancy (Table 2).

Figure 1:

Annual salary among male and female academic urogynecologists at public state universities

Table 2:

Crude and adjusted mean difference in salary for female compared with male urogynecologists

	Mean Difference (US$)	95% Confidence Interval (US$)
Crude	−54,237	−90,994, −17,480
Adjusted for academic rank	−40,937	−76,634, −5,241
Adjusted for administrative leadership	−32,427	−67,256, 2,403
Adjusted for educational leadership	−52,722	−87,598, −17,846
Adjusted for years since residency	−36,861	−76,363, 2,642
Adjusted for academic rank, administrative leadership, educational leadership, and years since residency	−37,955	−74,908, −1,001

DISCUSSION

We were able to demonstrate significant salary disparities within urogynecology. These differences persisted despite controlling for differences between male and female urogynecologists that could influence salaries. Our hope is that this study will raise awareness of existing disparities within the field and serve as a call to action.

Some seeking to explain the gender wage gap in medicine argue that women tend to choose lower wage-earning career paths and are less interested in leadership opportunities than men; however, the data to support this notion is lacking. Even among physicians with similar career trajectories there are significant salary disparities when stratified by gender. For example, an analysis of salaries for physicians who were granted NIH K08 and K23 career development awards showed a persistent gap in salary even after adjusting for specialty, academic rank, leadership positions, publications, and research time.⁵ Similarly, a cross-sectional analysis of 91,073 physicians found that salaries of female full professors were comparable to those of male associate professors, even when adjusting for physician age, seniority, specialty, scientific authorship, NIH funding, and clinical trial participation.⁶ Our study echoes the broader trends seen within medicine with significant salary disparities even in urogynecology despite controlling for potential important differences.

The salaries obtained for our study are slightly lower than those reported in other national surveys of urogynecologists. The Medical Group Management Association publication, perhaps one of the largest databases of hospital payments to physicians, reports a median salary for a full-time urogynecologist as $385,843 which is $96,434.09 higher than what we found in our study.¹¹ The salary reported by the this organization, however, represents the average earnings for a wide range of practice settings, including managed care organizations, private practice, and academic practice.

The American Urogynecologic Society, which is the largest non-profit organization representing professionals dedicated to treating female pelvic floor disorders, administers a biennial survey of its members. In 2011, responses were collected from 243 respondents, representing approximately 25% of members.¹² The survey found that the mean annual salary was $415,305 for male academic urogynecologists and $276,652 for female academic urogynecologists. While the AUGS salary numbers are self-reported, it is difficult to explain the magnitude of differences solely based on reporting bias. More recently, AUGS conducted a survey in 2017. While the 2017 report did not specifically look at the salaries of academic urogynecologists, overall, they found that male and female urogynecologists reported an average income of $400,000 and $320,000, respectively.¹³ Though these are self-reported numbers, the magnitude of the difference is difficult to overlook.

The self-reported salaries exceeding those found in our study may be explained by the fact that many academic surgeons have other sources of income, such as guest lectureship, pharmaceutical or medical device consulting fees, and medical-legal consulting; these additional revenue sources would not have been captured in the publicly available salary data.

The strengths of this study include the fact that salary data was obtained objectively from the publicly available database and therefore not constrained by the limitations and bias of self-reported salaries. One of the limitations is the fact that the sample size is relatively small and the majority of salary information is from a handful of academic institutions, which may not be generalizable to all academic institutions. Though we were able to perform linear regression with this dataset, salary data may be prone to skewness and thus warrant other analytic approaches, such as quantile regression.

CONCLUSION

Our findings show a significant salary disparity in academic urogynecology, which is consistent with national survey data demonstrating that salaries are higher for male than female physicians, even when accounting for variables such as specialty, academic rank and leadership roles. Physician compensation is complex; the differences observed may be due to variables that are not captured in this study. Nevertheless, the magnitude of disparity found in our study warrants further critical assessment of potential biases within the field and strategies to ensure equitable compensation models for all urogynecologists.