“Dr. Paid Less: An Old Title Still Fits Female Physicians”

And so begins a New York Times article about the recent JAMA Internal Medicine analysis of physician pay disparities. The central message of the analysis is that women in healthcare, on average, earn $20,000 less per year than their specialty-matched male colleagues. While this is significant and concerning, we must not lose sight of the context. Salary is important, but it’s only one piece of the puzzle for us women in healthcare.

Only one or two generations ago, women who were admitted to medical school-the few, the proud, the just-one-of-the-guys-had innumerable hurdles to overcome. They were a tiny minority of their medical school classes. They often entered healthcare knowing they would have to make a choice between a career and marriage/family, both because society found them odd and many men were not interested, and because they had to work harder and longer than their male colleagues to prove they were “man enough” to handle a career in healthcare. Their personal lives were subject to scrutiny and questioning. A friend who is a retired OB/Gyn was asked at her residency interview what type of birth control she and her husband would be using, as the program wanted to avoid admitting a woman who might become pregnant during training. The lab, the classroom and the doctor’s lounge were male-dominated, both in person and in language and humor. Patients often assumed they were nurses, and colleagues often assumed they were unable to keep up the pace required. And, outside of the world of healthcare, society made assumptions as well. I remember my grandmother referencing my great-aunt’s career as a pathologist and faculty member at Georgetown University Medical School as a scandalous career in which she “saw all those naked men.” The women physicians of preceding generations had to be tough, smart and laser-focused in order to make it in healthcare.

In contrast, today women make up the majority of students in medical training in this country. Nearly a third of all practicing physicians are women, and they account for more than 60 percent of pediatricians and more than 51 percent of OB/Gyns. No woman applicant today is ever asked about her marital status, much less her birth control. On the surface, it would appear the challenges those early women in healthcare experienced are nothing but the comical stories of an age gone by. But then articles like this pop up in the literature as jarring reminders that men’s and women’s experiences of life and career are different: “The $16,819 Pay Gap For Newly Trained Physicians: The Unexplained Trend Of Men Earning More Than Women.” This 2011 article reported not just a wage gap, but an increased wage gap as compared to 1999. And now, in 2016, we have another article with the same story: women physicians earn less. The question no one has yet been able to answer is: why?

Do women in healthcare earn less because we are less valued by our profession or society? Do we earn less because we don’t negotiate well and can’t advocate for ourselves? These ideas may well be a part of the problem. But I suspect the answer is far more complex.

A 2015 study of hospitalists showed that women hospitalists earned $14,581 less annually than their male colleagues, but those same women ranked pay much lower on a list of satisfaction domains than their male colleagues.

Matthew Lewin, MD, PhD, postulates that women “in professional marriages typically take primary responsibility for child rearing and management of domestic issues. Furthermore, women in dual-physician marriages are more likely to subjugate their careers in an effort to promote family well-being.”

Similarly, Huffington Post blogger and medical student Maximilian Martinez submits that “as women pause their careers for childbirth and childcare they face ‘the motherhood wage penalty’-delays in training and promotion that may lead to lower wages. Moreover, women may choose lower-paying jobs or specialties with more flexible work schedules in order to balance their work and family life. Although these women are being paid less, they may be purposely seeking out employment arrangements that compensate them in other, non-financial ways, such as with on-site childcare, shorter commutes, and flexible schedules.”

Why do women in healthcare earn less than men? I could continue quoting articles with varying ideas and points of view. But, like any good veteran of multiple-choice tests, I am going to answer this one: “D) All of the above.”

We women in healthcare do continue to experience some discrimination, and it is greater in some specialties than in others. We still have to navigate some settings carefully because the professional woman-and especially the professional Christian woman-remains an anomaly in some parts of our society. We do sometimes have to prove ourselves in ways our male colleagues do not. In addition, many of us likely do not advocate well for ourselves. Self-promotion and asking for more is not what many of us have been taught is polite. There are ways in which healthcare and society still need to change and adapt, and there are things we women healthcare professionals still need to learn.

But there are also choices we make. I would wager most of us, especially those of us who are Christians, do take primary responsibility for home and children. I’m not here to argue whether or not that is right or biblical…that’s a larger discussion for another day. I’m simply stating that most of us do. We also choose work settings that benefit our families and compensate us in ways that work for the family overall, which is not necessarily equal to the highest dollar figure. Do men sometimes do this as well? Certainly. Do they do it as often as women? I don’t have data to quote, but in my observation, they do not. However, we women are not forced to make these choices. We make them because we choose to do what we see is in the best interest of our families. We could make different choices which would bring more money, but we have to ask ourselves what we would lose in exchange. Would it be a good decision to trade the positives of a lower paying job for the negatives of a higher paying one? In some situations, it would. But in many, it would not.

Now that I have wandered from wage inequity to potential discrimination to voluntary choices, where should each individual woman healthcare professional land on this issue? I propose we land in the same exact place Christians should always land on every issue: right in the center of God’s will for us and our families. Of course, understanding God’s will for us is a bit more complicated! But prayer, wise counsel, thoughtful discussion with spouses and friends and time in Scripture ultimately lead to God’s guidance for us as individuals. For some of us, learning to negotiate better and advocating for a raise is the best thing for us and our families. For others, it’s a different job with higher pay. For still others, it’s a different job with lower pay! I have friends from medical school who are currently stay-at-home moms-and more power to them, if that’s where God has called them for this stage of their families’ lives. I think generalized statements about women in healthcare are as impossible as generalized statements about people in general. We are each unique. Our families are unique with each family being its own little civilization. There is no one-size-fits-all solution to these difficult questions. But there is one God whose size is big enough and powerful enough for all the answers we need.