Gender Gaps in Salary and Representation in Academic Internal Medicine Specialties in the US

Abstract

This cross-sectional analysis examines survey data on academic physician salaries from 2018 to 2019 using the Association of American Medical Colleges Faculty Salary Report to evaluate demographics and salaries of academic internal medicine physician specialists.

Women comprise 41% of faculty in full-time academic positions, steadily increasing since 2009.¹ The number of women pursuing Internal Medicine (IM) careers continues to rise; however, gender differences in physician salary and promotion have endured.² Contemporary data on the workforce composition of IM subspecialist physicians are lacking. We sought to evaluate current demographics and salaries of academic IM physician specialists and hypothesized that gender disparities in remuneration persist despite the increase in female representation in academic IM.

Methods

In this cross-sectional analysis, we examined the most recently available summary survey data on academic physician salaries from the 2018 to 2019 Association of American Medical Colleges (AAMC) Faculty Salary Report,³ spanning fiscal year 2018 to 2019. Data were deidentified and therefore not subject to institutional review board approval per University of Pennsylvania protocols. Institutional survey respondents provided total compensation rounded to the nearest thousand for each full-time faculty member, which were then aggregated. We report descriptive statistics on median annual salary, faculty rank, and gender for 21 905 faculty within 13 IM specialties at 154 United States medical schools. Female representation was calculated as a proportion of total faculty count.

Results

In 2018 to 2019, women comprised fewer than 50% (8662/21780) of total full-time faculty across all ranks. Although female representation was nearly equal at the instructor (715/1512 [47%]) and assistant ranks (4828/10457 [46%]), it decreased to 24% at higher ranks (female professor, 1057/4340) (Figure 1A). Women were the majority in 3 specialties: general IM, endocrinology, geriatrics. Procedural specialties (pulmonology, critical/intensive care, gastroenterology, cardiology) had the fewest female faculty. Cardiology exhibited the greatest imbalance with only 21% (664/3112) women (Figure 1B).

Figure 1. Gender-Based Salary and Representation Disparities in Internal Medicine in 2018 to 2019.

A, Median annual salary for women was uniformly lower compared with men across all faculty levels within internal medicine. Female representation was nearly equal at the most junior faculty rank but declined with each rank of faculty promotion. B, Median annual salary for women was lower compared with men across internal medicine specialties but reached higher than 90% of male salaries in 10 of 13 specialties (blue line, right y-axis).

Women’s median annual salary was lower across all faculty ranks but remained within an absolute difference of $25 000 at all ranks except for Chief. When analyzed by IM specialty, women were paid at least 90% of men’s median annual salary in 10 of 13 IM specialties. However, when examined by rank, men’s salaries still exceeded women’s in 56 of 62 categories (90%). The 3 specialties in which women’s median salary did not reach 90% of men’s—cardiology, gastroenterology, critical/intensive care—tended toward higher remuneration in total but also demonstrated the largest gender disparities in both representation and salary, particularly within the higher ranks of cardiology and gastroenterology (Figure 2).

Figure 2. Gender-Based Salary Disparities in Internal Medicine Specialties in 2018 to 2019, by Rank.

Median women’s salary as a percentage of men’s salary, by specialty and faculty rank. Men’s salaries surpassed women’s salaries in 56 of 62 categories of faculty rank in 13 internal medicine specialties. Equivalence point of women’s and men’s salaries is displayed as the black line at 100%.

Discussion

Our analysis of the 2018 to 2019 AAMC Faculty Salary Report from 154 US medical schools demonstrates persistent salary differences by gender and representation disparities in IM specialties, despite the increasing number of women in IM. We found that nonprocedural IM specialties exhibited closer parity in both salary and representation, whereas procedural specialties had low female representation with the largest salary disparities.

Within IM, unadjusted salary differences between genders appear to be improving over time. Yet, substantial salary inequities persist at the highest faculty levels and specifically in procedural-based specialties.⁴ Our findings regarding the disparities in procedural IM specialties align with recent works that examined both academic and nonacademic physician salaries and found that the largest gender differences in salary across multiple medical and surgical specialties existed among specialties and practices with the highest proportion of male physicians.^5,6 The reasons for this remain unclear; IM procedural specialties have long been male dominated in composition and leadership, despite increasing gender parity in the preceding training stages. Taken together, these findings suggest that workforce gender parity was associated with salary equity, and further investigation of the disparities in procedural specialties is needed.

Limitations include inability to adjust for additional individual-level factors that may affect salary, including professional service, academic productivity, clinical volume, and ancillary funding sources, and these factors are likely also influenced by gender, race, and geography. Our findings may not be generalizable across all US medical schools given the heterogeneity in IM departmental structures. Despite the influence of potential confounders, these unadjusted gender-disaggregated data provide important insights regarding physician workforce composition and salary.

Our findings suggest that salary disparities persist in US IM specialties and are most pronounced in procedural specialties with fewer women. These findings emphasize the importance of gender diversity to achieving salary parity in IM subspecialties and highlight opportunities to improve representation and salary equity in IM procedural specialties.