Abstract
This study investigates whether sex pay differences exist among clinical department chairs from 29 state medical schools in 12 states.
Women in academic medicine are paid less than their male peers.1,2 This salary difference is often attributed to differences in rank and promotion. The goal of this study was to investigate whether sex pay differences exist at the highest ranks of academic medicine: among clinical department chairs. Given that department chairs are exceptional leaders who have reached the top rank of their specialties, we hypothesized that there would be no significant differences in salary between female and male department chairs.
Methods
We extracted 2017 salary data from 29 state medical schools in 12 states that had public employee salary data available online. We included all 20 Accreditation Council for Graduate Medical Education pipeline specialties (leading to board certification) with more than 80 residency training programs nationwide from 2016 to 2017.3 We used websites to identify chairs of each clinical department as described previously.2 If no chair could be identified, division chiefs, interim, or acting chairs were identified. Two authors (M.M. and W.B.) independently verified chair identities and term lengths through press releases, newsletters, Doximity, and LinkedIn. Peer-reviewed scientific publications were identified through PubMed, and lifetime National Institutes of Health grants were identified through the National Institutes of Health Reporter. This study was exempt from institutional review board because it represents research on organizations rather than individuals; as such, no written or oral consent was obtained. Data were gathered between November 1, 2018, and January 31, 2019.
Analysis began February 2019. We calculated adjusted salary differences using linear regression of log-transformed inflation-adjusted 2017 earnings, controlling for title (eg, permanent vs interim), term length, specialty, and regional cost of living. We conducted 3 sensitivity analyses. Our first sensitivity analysis removed potentially erroneously low salaries by excluding interim department chairs and chairs at schools where most chairs were compensated below three-fourths of the 25th percentile within their specialty. Our second sensitivity analysis controlled for numbers of publications and National Institutes of Health grants. Our third sensitivity analysis controlled for publications and grants and additionally controlled for differences in state databases reporting by including database-level fixed effects. Two-sided P values with a significance threshold less than .05 were used.
Results
Our sample consisted of 550 department chairs across 29 US public schools of medicine (Table 1), representing almost half of public medical school department chairs whose salaries were reported to the Association of American Medical Colleges from 2017 to 2018 (N = 1073).4 A total of 92 chairs (16.7%) were women. The unadjusted mean difference in annual salary by sex was $79 061 (95% CI, $23 103-$135 020; P < .01; mean [SD] for men: $452 359 [$252 411] and for women: $373 298 [$196 304]). After adjusting for term length, specialty, inflation, title, and regional cost of living differences, the salary difference by sex was $67 517 (95% CI, $13 474-$121 561; P = .02). Sex salary differences persisted in sensitivity analyses additionally controlling for academic productivity and salary database (Table 2). Among chairs who served for more than 10 years, men were paid significantly more than women ($127 411 [95% CI, $55 028-$199 793]; P < .01).
Table 1. Sample Characteristicsa.
| Characteristic | No. (%) | P Value | |
|---|---|---|---|
| Men | Women | ||
| Total No. | 458 | 92 | NA |
| Salary, $ | |||
| Mean (SD) | 452 359.15 (252 411.41) | 373 297.99 (196 304.30) | <.01 |
| Median (IQR) | 427 374.80 (266 417.90-604 551.10) | 356 644.70 (202 958.70-489 525.50) | <.01 |
| Salary category, $ | |||
| <250 000 | 100 (22.6) | 28 (31.8) | .02 |
| 250 000-499 999 | 165 (37.2) | 39 (44.3) | |
| 500 000-749 999 | 128 (28.9) | 19 (21.6) | |
| 750 000-999 999 | 41 (9.3) | 1 (1.1) | |
| 1 000 000 | 9 (2.0) | 1 (1.1) | |
| Official title | |||
| Department chair | 374 (81.7) | 63 (68.5) | <.01 |
| Interim | 42 (9.2) | 21 (22.8) | |
| Acting | 2 (0.4) | 1 (1.1) | |
| Division chief | 40 (8.7) | 7 (7.6) | |
| Term length, y | |||
| Mean (SD) | 9.4 (7.6) | 5.4 (4.4) | <.01 |
| Median (IQR) | 7 (3-13) | 4 (2-8) | <.01 |
| Term length by category, y | |||
| 0-4.9 | 147 (33.2) | 49 (54.4) | <.01 |
| 5-9.9 | 124 (28.0) | 26 (28.9) | |
| ≥10 | 172 (38.8) | 15 (16.7) | |
| Specialty | |||
| Anesthesiology | 23 (5) | 2 (2.2) | .03 |
| Dermatology | 21 (4.6) | 5 (5.4) | |
| Emergency medicine | 22 (4.8) | 4 (4.4) | |
| Family medicine | 20 (4.4) | 13 (14.1) | |
| Internal medicine | 29 (6.3) | 7 (7.6) | |
| Neurological surgery | 25 (5.5) | 2 (2.2) | |
| Neurology | 25 (5.5) | 3 (3.3) | |
| Obstetrics and gynecology | 24 (5.2) | 9 (9.8) | |
| Ophthalmology | 20 (4.4) | 4 (4.4) | |
| Orthopedic surgery | 24 (5.2) | 1 (1.1) | |
| Otolaryngology | 26 (5.7) | 1 (1.1) | |
| Physical medicine and rehabilitation | 15 (3.3) | 3 (3.3) | |
| Pathology | 21 (4.6) | 6 (6.5) | |
| Pediatrics | 24 (5.2) | 9 (9.8) | |
| Plastic surgery | 21 (4.6) | 3 (3.3) | |
| Psychiatry | 23 (5) | 6 (6.5) | |
| Radiation oncology | 18 (3.9) | 4 (4.4) | |
| Radiology | 26 (5.7) | 4 (4.4) | |
| Surgery | 28 (6.1) | 5 (5.4) | |
| Urology | 23 (5) | 1 (1.1) | |
| Census regions | |||
| Midwest | 121 (27.0) | 33 (35.9) | .18 |
| South | 211 (47.1) | 35 (38.0) | |
| West | 116 (25.9) | 24 (26.1) | |
Abbreviations: IQR, interquartile range; NA, not applicable.
Medical schools included University of California, Davis, Davis; University of California, Irvine, Irvine; University of California, Los Angeles, Los Angeles; University of California, San Diego, San Diego; University of California, San Francisco, San Francisco; East Carolina University, Greenville; University of North Carolina, Chapel Hill; University of Florida, Gainesville; University of South Florida, Tampa; Southern Illinois University, Carbondale; University of Illinois at Chicago, Chicago; University of Illinois at Peoria, Peoria; University of Illinois at Rockford, Rockford; University of Illinois at Urbana, Urbana; University of Kansas, Lawrence; University of Maryland, College Park; University of Michigan, Ann Arbor; Ohio State University, Columbus; University of Tennessee at Chattanooga, Chattanooga; University of Tennessee at Knoxville, Knoxville; University of Tennessee at Memphis, Memphis; University of Texas at Houston, Houston; University of Texas at San Antonio, San Antonio; University of Texas at Austin, Dell Medical School, Austin; University of Texas MD Anderson Cancer Center, Houston; UT Southwestern Medical Center, Dallas, Texas; Texas Tech University, Lubbock; University of Washington, Seattle; and University of Wisconsin, Madison.
Table 2. Sensitivity Analyses on Salary by Sex.
| Sensitivity Analysis | No. of Chairs | Sex Difference in Salary [M-F] (95% CI), $ | P Value | F Cents per M Dollar (95% CI), $a | P Value |
|---|---|---|---|---|---|
| All individualsb | 514 | 67 517.05 (13 474.29 to 121 560.80)c | .02 | 0.87 (0.71 to 1.03) | .12 |
| Excluding potentially erroneous salariesb | 214 | 119 072.50 (49 427.39 to 188 717.70)c | <.01 | 0.76 (0.58 to 0.95)c | .02 |
| Adjustment for publications and NIH grantsd | 257 | 63 632.25 (2757.13 to 124 507.40)c | .04 | 0.85 (0.72 to 0.98)c | .03 |
| Adjustment for publications, NIH grants, and state salary databasee | 257 | 47 230.82 (−11 969.39 to 106 431) | .11 | 0.88 (0.76 to 1.00)c | .045 |
Abbreviations: F, female; M, male; NIH, National Institutes of Health.
Female cents per male dollar was derived from a linear regression on log-transformed salary.
Adjusted for term length, specialty, inflation, title, and regional cost of living differences according to the 2017 Consumer Price Index while clustering standard errors by medical school.
P < .05.
Adjusted for term length, specialty, inflation, title, regional cost of living differences according to the 2017 Consumer Price Index, number of publications, and number of NIH grants while clustering standard errors by medical school.
Adjusted for term length, specialty, inflation, title, regional cost of living differences according to the 2017 Consumer Price Index, database, number of publications, and number of NIH grants while clustering standard errors by medical school.
Discussion
Our study shows sex differences in salaries of clinical department chairs in US public medical schools. After adjusting for academic productivity and multiple other factors, women earned $0.88 for every dollar received by men.
Limitations include lack of data to account for race/ethnicity or the Northeast. Additionally, chair compensation reported in public data was generally lower than compensation reported in Association of American Medical Colleges public medical school faculty survey reports.4 This may reflect exclusion of medical practice earnings and bonus pay in our data. However, we do not believe including these forms of compensation would substantially change our conclusions because our sensitivity analysis excluding potentially erroneously underreported salaries increased observed sex differences in salary.
The observed salary disparities reveal the pervasiveness of sex inequity even at the highest levels of academic medicine’s hierarchy. These findings call into question common historical justifications for sex inequities in salary, as the women in our sample have demonstrated career commitment and negotiation experience. Our findings suggest that structural, rather than individual, solutions are needed to achieve sex salary equity.
References
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