The ground that women lose now will likely have a profound effect for many years to come, perhaps putting them at a disadvantage for the rest of their careers

In many countries, including the United States and United Kingdom, women make up the majority of the medical workforce, so it is not surprising that in the early part of the pandemic US women comprised approximately 3 out of every 4 cases of healthcare workers infected with the novel coronavirus. As women risk their lives in disproportionately high numbers, it is worthwhile to consider not only how the virus has affected their physical and emotional health, but also their financial wellbeing. Indeed, covid-19 has come at a high cost for women in medicine and exacerbated many pre-existing gender-related compensation disparities.

Prior to the start of the pandemic a robust body of literature spanning more than a decade already demonstrated pay gaps for women physicians and scientists. Even after accounting for co-variates such as part-time work, decreased productivity, and numerous other factors, scientific studies consistently revealed unjustified gender-related pay gaps. For example, a Canadian study evaluated more than 1.5 million surgical procedures and found that of the 3,275 surgeons involved, hourly earnings for female surgeons were 24% lower than for male surgeons. This disparity persisted after adjusting for variables such as specialty. The researchers concluded, “Even within a fee-for-service system, male and female surgeons do not have equal earnings for equal hours spent working”, and they recommended systems-level solutions.   

Importantly, pay gaps may be greater for women with intersectional identities such as women from ethnic minorites, as bias and discrimination is more profound. An analysis of physician compensation studies spanning from 2013-2019, found that most of the studies were unfunded and women comprised the majority of researchers and disseminators of the work. The science demonstrates that gender-related pay gaps often begin with the first job after training and continue throughout careers—costing women hundreds of thousands or even millions of dollars in lost compensation, retirement, and investment income. 

Though research is limited regarding how the pandemic is affecting compensation, many medical centers have reported facing financial crises and cutting hours, compensation, benefits, and jobs of many workers, including physicians, and there is reason to worry that women will likely be disproportionately affected both by present cuts and by the future financial impact of current events. Women will, as always, but now even more acutely, face disadvantages from unconscious bias in decisions about whose pay should be cut, whose operating schedules should take priority when resources are limited, and whose contributions merit retention. Several reports have demonstrated that women in academic medicine are publishing less during the pandemic, and this will inevitably affect their ability to secure future grant funding as well as to be promoted and achieve the higher levels of compensation typically associated with higher rank. 

For example, a recent article in Nature Index highlighted numerous areas of concern affecting women researchers and their productivity overall as well as authorship on pandemic-related papers. The disparities seem to be more profound in early career women, and this is alarming, because they are in the most precarious financial situation compared to male peers as well as more senior men and women due to low compensation, high educational debt, and a disproportionately high level of childcare responsibilities. A study in the US using mixed-effects regression models estimated that the proportion of papers with a woman first author was 19% lower for covid-19 papers compared to 2019 papers published in the same journals. 

A survey of Italian healthcare workers during covid-19, primarily comprised of women, found that 44% of participants reported an increased workload. Women were significantly more likely than men to report this increase in work volume. In the US, compared to male colleagues in academic medicine, women are disproportionately represented on clinician-educator tracks which means they are more likely to have increased burdens of not only direct covid-19 related care, but also transitioning clinical care and medical education to virtual platforms. Women have historically taken on more “non-promotable” work than men and pitched in to a greater degree on projects that impact a group or organization. Numerous, though not all, studies report that women physicians have higher rates of burnout. At baseline, financial stress is a major contributor to burnout for women in medicine. Additional uncompensated clinical and administrative volume at work will likely have an additive effect on financial stress and burnout for these women.  

For women in medicine who are now on the front lines saving the lives of countless individuals and have been fighting for fair pay and equal opportunities to advance in their careers, the novel coronavirus pandemic has exacerbated pre-existing disparities related to their financial health. Given the deeply troubling body of literature demonstrating pay gaps for women in medicine, we can anticipate that the novel coronavirus pandemic will disproportionately affect their earnings, savings, and debt compared to male peers. Moreover, the ground that women lose now will likely have a profound effect for many years to come, perhaps putting them at a disadvantage for the rest of their careers.  

Julie K. Silveris an Associate Professor and Associate Chair of the Department of Physical Medicine at Harvard Medical School. Dr. Silver is on the medical staff at Massachusetts General, Brigham and Women’s, and Spaulding Rehabilitation Hospitals. Twitter: @JulieSilverMD

Allison R. Larson, Associate Professor, Vice Chair for Education, Residency Program Director, Department of Dermatology, Boston University

Reshma Jagsi, Newman Family Professor, Director, Center for Bioethics and Social Sciences in Medicine; Deputy Chair, Department of Radiation Oncology, University of Michigan

Competing interests: JS, AL and RJ have no disclosures related to this work.

JS has participated in research funded by The Arnold P. Gold Foundation (physician and patient care disparities research) and the Binational Scientific Foundation (culinary telemedicine research). She is an uncompensated founding member of TIME’S UP Healthcare.  

AL has served on a one-time advisory board for Sanofi Genzyme on resident education and has received honoraria for invited lectures such as medical conference and Grand Rounds lectures. 

RJ has received personal fees from Vizient for preparing a presentation and for consulting work for Amgen for unrelated work.  She has grant funding for unrelated work from the National Cancer Institute, the Greenwall Foundation, the Susan G. Komen Foundation, and the Doris Duke Charitable Foundation; within the past 36 months, she previously received grant funding for unrelated work from Blue Cross Blue Shield of Michigan.  She is an uncompensated founding member of TIME’S UP Healthcare.  She has stock options in Equity Quotient, a company that promotes equity in healthcare, for her service as an advisor.

References:

Characteristics of Health Care Personnel with COVID-19—United States, February 12-April 9, 2020. MMWR Morb Mortal Wkly Rep 2020;69:477-481. https://www.cdc.gov/mmwr/volumes/69/wr/mm6915e6.htm?s_cid=mm6915e6_w Accessed on 11 July 2020. 

Racial and Gender Factors in Compensation. Medscape Female Physician Compensation Report, 2019. Medscape. https://www.medscape.com/slideshow/2019-compensation-female-physician-6011698#9″ https://www.medscape.com/slideshow/2019-compensation-female-physician-6011698#9 Accessed on 11 July 2020.

Dossa F, Simpson AN, Sutradhar R, Urbach DR, Tomlinson G, Detsky AS, Baxter NN. Sex-Based Disparities in the Hourly Earnings of Surgeons in the Fee-for-Service System in Ontario, Canada. JAMA Surg. 2019 Dec 1;154(12):1134-1142. doi: 10.1001/jamasurg.2019.3769. PMID: 31577348; PMCID: PMC6777399.

Larson AR, Cawcutt KA, Englander MJ, Pitt SC, Ansari E, Liu HY, Silver JK. Representation of Women in Authorship and Dissemination of Analyses of Physician Compensation. JAMA Netw Open. 2020 Mar 2;3(3):e201330. doi: 10.1001/jamanetworkopen.2020.1330. PMID: 32196102; PMCID: PMC7084168.

Lo Sasso AT, Armstrong D, Forte G, Gerber SE. Differences In Starting Pay For Male And Female Physicians Persist; Explanations For The Gender Gap Remain Elusive. Health Aff (Millwood). 2020 Feb;39(2):256-263. doi: 10.1377/hlthaff.2019.00664. Epub 2020 Jan 22. PMID: 31967925.

Mensah M, Beeler W, Rotenstein L, Jagsi R, Spetz J, Linos E, Mangurian C. Sex Differences in Salaries of Department Chairs at Public Medical Schools. JAMA Intern Med. 2020 Mar 2;180(5):789–92. doi: 10.1001/jamainternmed.2019.7540. Epub ahead of print. PMID: 32119059; PMCID: PMC7052792.

Silver JK. Understanding and addressing gender equity for women in neurology. Neurology. 2019 Sep 17;93(12):538-549. doi: 10.1212/WNL.0000000000008022. Epub 2019 Jul 31. PMID: 31366723.

1-in-5 Physicians Hit with Pay Cut or Furlough due to Covid-19 Survey Says. Becker’s Hospital Review. Accessed on July 14, 2020. https://www.beckershospitalreview.com/compensation-issues/1-in-5-physicians-hit-with-pay-cut-or-furlough-due-to-covid-19-survey-says.html

The Decline of Women’s Research Production During the Coronavirus Pandemic. Nature Index. 2020 May 19. https://www.natureindex.com/news-blog/decline-women-scientist-research-publishing-production-coronavirus-pandemic Accessed on 10 July 2020.

Andersen JP, Nielsen MW, Simone NL, Lewiss RE, Jagsi R. COVID-19 Medical Papers have Fewer Women First Authors than Expected. Elife. 2020 Jun 15;9:e58807. doi: 10.7554/eLife.58807. PMID: 32538780; PMCID: PMC7304994.

Felice C, Di Tanna GL, Zanus G, Grossi U. Impact of COVID-19 Outbreak on Healthcare Workers in Italy: Results from a National E-Survey [published online ahead of print, 2020 May 22]. J Community Health. 2020;1‐9. doi:10.1007/s10900-020-00845-5.

Mayer AP, Blair JE, Ko MG, Hayes SN, Chang YH, Caubet SL, Files JA. Gender Distribution of U.S. Medical School Faculty by Academic Track Type. Acad Med. 2014 Feb;89(2):312-7. doi: 10.1097/ACM.0000000000000089. PMID: 24362384.

Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide. Medscape. https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460″ https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460 Accessed on 11 July 2020.