key: cord-0060735-njfozo60
authors: Gottlieb, Amy S.
title: A Road Map for Closing the Gender Pay Gap in Medicine: How Organizations Can Begin the Journey
date: 2020-10-29
journal: Closing the Gender Pay Gap in Medicine
DOI: 10.1007/978-3-030-51031-2_8
sha: 81bc83656ea08077b18bd9eed3243f8d025895b3
doc_id: 60735
cord_uid: njfozo60

The gender pay gap in medicine represents the convergence of multiple forces that reward the way men physicians have typically worked and lived for decades. This traditional paradigm is not inherently better than a more equitable one that accounts for the unique contributions of women physicians as well as the demands and biases facing them. A more inclusive approach has the potential to generate superior outcomes within our industry, incentivize the right types of care, and engage the full talents of a considerable portion of the workforce. Closing the gender pay gap is achievable with organizational commitment and openness to culture and process change. It also requires funding, especially up front. Our road map emphasizes the importance of robust salary studies and efforts to clarify how the cost of equity will be forecasted, managed, and monitored. Closing the gender pay gap is a business proposition and, by treating it with the same attention to detail and rigor as they do other operating expenses, organizations can assess progress and cost and also normalize it as an ongoing enterprise effort.

institutions can go about taking a hard look at basic assumptions that underlie their compensation methodologies to understand the expectations they generate. These expectations may not be consistent with twenty-first-century work patterns or the types of clinical outcomes and business results healthcare enterprises are now seeking. Additionally, our authors have offered detailed guidance on building the governance structures and institution-wide coalitions necessary to incorporate principles of equity into usual human resources, finance, and departmental practices. For senior leaders who understand the value of recruiting, retaining, and rewarding their physician workforce fairly, the preceding chapters describe how organizational transformation to sustain equity is achieved through open dialogue, consistent messaging, and thoughtful communication cascaded throughout the institution. Transparency about the status quo and efforts to improve it, as well as challenges and successes, is what will ultimately drive culture change toward salary equity and build trust among women physicians that leadership genuinely seeks to eliminate gender pay disparities.

Organizational compliance with statutory mandates is indeed a critical element in the movement toward salary equity but, as savvy leaders know, it cannot be the driving force. Harnessing talent by equitably rewarding contributions of the entire physician workforce is the most compelling rationale. The cost of doing business the old way runs the risk of incentivizing the wrong types of care and disengaging a considerable proportion of the workforce that supports enterprise viability and vitality. Since compensation is the single largest expense in our labor-intensive industry, paying more attention to human capital investment and compensating our physician workforce appropriately seem fiscally prudent as well as ethically sound [1] . As several of our authors note, closing the gender pay gap will require funding, especially up front. However, organizations routinely prioritize capital expenditures, and so, the hurdle here is as much about shifting perceptions of need as the actual dollars required for the effort.

The road map to closing the pay gap begins with understanding the current institutional landscape and, as such, starts with a robust salary study that is approached with the following questions in mind:

• Who should conduct the study? How, with whom, and when will results be shared? • Which level of analysis would be most useful to examine existing salary disparities (department, division, individual)? Is reliable salary data available at that unit of analysis? (If not, why and how can the data be improved upon going forward?) • Which benchmarks (external and internal) should be utilized and what are the standards for assessing their rigor? • Which professional duties are considered similar enough for comparison and which factors delineate differences? • What currently defines clinical, educational, and research productivity? Is the data that has been collected in these domains reliable? (If not, why and how can the data be improved upon going forward?)

• Do productivity metrics reflect enterprise goals such as patient-centered care, quality, and value? Are there pockets of productivity (e.g., mentoring trainees, performing service-related tasks for the organization) that are being ignored when it comes to compensation? • What other factors affect compensation (e.g., career advancement opportunities) and therefore need to be considered when assessing pay differences? At what level (e.g., department, division) should these inequities be assessed and then rectified going forward?

The last bullet point above merits further exploration, especially since disparities in leadership roles have been associated with the gender pay gap in medicine [2] . Leadership opportunities typically accrue to those who are deemed promotable, and our authors have done an outstanding job delineating the biases in performance evaluation, sponsorship, and expectations around "non-promotable," service-related tasks that impede women's professional advancement. Fortunately, there are relatively simple strategies organizations can adopt to mitigate their effects on compensation. For example, leaders and their deputies can allocate citizenship tasks more equitably (e.g., on a rotating basis), monitor these responsibilities, and recognize them in promotion metrics and compensation methodologies. They can also begin to talk openly about biased language in performance evaluations and encourage supervisors, through training and audits, to pay attention to these situations in which gender biases emerge. Equally important, organizations can support transparency around professional opportunities by developing standards for communicating open leadership positions and widely disseminating calls for applications.

In addition to designing and conducting robust salary studies, institutions should consider the following questions as they forecast the cost of closing the gender pay gap:

• How far back should corrections for pay disparities go (e.g., just the current year or the past five years for those eligible)? • In academic medical institutions, how should the clinical, educational, and research enterprises share responsibility for the expense of correcting salary inequities? • How do equity adjustments interface with customary merit and incentive pay practices and what is the process and timeline for fully correcting identified compensation disparities (e.g., lump sum payout, distribution over a certain period)? • What is the plan for monitoring pay equity and making adjustments after initial corrections?

Once again, the last bullet point above merits further consideration. As has been emphasized throughout this book, closing the gender pay gap in medicine is a business proposition as much as an ethical one. Organizations should treat it as such, monitoring its status, progress, and cost with the same attention to detail and rigor as they do other operating expenses. Pay equity metrics should be reported to business unit leaders (e.g., health system, department, division, and practice leaders) in the same fashion and with the same regularity as data used for operating margin surveillance. Similarly, leaders should have goals and accountability for pay equity results, and there should be an institutional appetite to discuss challenges and opportunities to achieving them. Addressing salary equity as part of routine business practice allows it to be monitored readily and also normalizes it as an ongoing effort that requires constant attention like other expenses.

After finishing this book, I expect that readers will have a deeper understanding of the compensation methodologies, organizational practices, and cultural expectations that perpetuate the gender pay gap among our physician workforce. My hope is that the road map offered herein will also allay concerns about how best to approach the problem and inspire institutional leaders to begin to effect meaningful change in the policies and practices over which they hold sway to close the gender pay gap in their organizations.

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