WHAT IS “VALUE” FOR WOMEN IN MEDICINE?

From the moment we began the research for Season One of Lost Women of Science, we asked a central question: was Dr. Dorothy Andersen, the pioneering pathologist, valued in the medical community? As our recent bonus episode shows, the word “value” is itself complicated. 

The episode–“The Resignation”–describes a single telling incident that happened in this building, Columbia’s old Babies Hospital. In 1949, the chief of pediatrics, Rustin McIntosh, threatened to resign if Dorothy Andersen was moved to a different building—a strategic play that proved successful when the board of the hospital dropped plans for the move. So yes, Dr. Andersen’s medical work was valued so highly that her boss was willing to resign at the height of his career if she was so much as relocated. 

But did Dr. Andersen reap appropriate value from her valuable work? Given the 25 years it took for her to achieve a full professorship (McIntosh was awarded one within a decade), and the likelihood that she was paid considerably less than her male colleagues (a study, shown below, found that male doctors out-earned female doctors by 69.8% on average in 1949), it would be difficult to make that case.

This month’s newsletter gives a snapshot of the current state of this discrepancy—between value given and value gotten—that continues to affect women in medicine.

VALUE GIVEN

Several studies have shown that women provide quantifiably better medical care than men in terms of patient outcomes.

We’re talking about three studies here—one small study from 2002, and two much larger ones from 2017, which included hundreds of thousands and millions of patients’ data respectively. None of the studies tracked the effects of the doctors’ race or ethnicities, and none identified any trans or nonbinary doctors (the two 2017 studies relied on existing databases that required participants to identify as either male or female).

The 2002 study found that women tended to spend more time communicating with patients than male physicians, a practice that has been linked to better patient outcomes in other studies. The 2017 studies found that patients who saw female doctors (internists and surgeons respectively) had a small but statistically significant decrease in 30-day mortality compared with male doctors. 

It’s unclear what exactly accounts for the gender disparities in quality of care. All the studies warn against chalking it up to gender itself, and point instead to “practice patterns,” the ways men and women address patient care differently. The studies also advocate for future research that would investigate those practice patterns–what they are, and how and why they differ for men and women.

VALUE (NOT) GOTTEN 

A recent study from the medical journal Health Affairs finds that over a 40-year career, a female doctor makes at least $2 million less than a male counterpart. This amounts to a near 25% percent difference in earnings for people in comparable positions over the course of their careers.

A New York Times article on the findings notes that this is the largest published analysis of doctor’s salaries, and the first to include the cumulative effect of the gender wage gap. The article also points out that while the study was conducted using data from 2014 to 2019, the gap has likely widened since the onset of the pandemic, which caused many female doctors to leave work and tend to household responsibilities and children, decreasing their cumulative earnings.

Impacts of the pay gap on nonbinary or trans doctors were not reflected in the study, nor were the effects of race on pay, a factor known to profoundly impact salary. 

The study did account for the tendency for women to fill lower-paid roles in general—quite possibly another effect of gender discrimination—and compared only those doctors in comparable positions. Had it included these differences in roles, the lead author estimates that the gap would have “roughly doubled.”

Interestingly, the study also points to women spending more time with their patients as a factor in their reduced earnings, since the extra time is not billable. If you remember from above, this practice pattern is also linked to better patient outcomes. Women get paid less for doing better medical work.

WHAT??

In the circumstances discussed by these studies, patients of female doctors benefit from better medical practices and outcomes, and those female doctors make significantly less money than their male colleagues.

Used in this context, value is an imprecise term. It works better if you split it in half; on one side is medical effectiveness, and on the other is compensation. If we can make this distinction, we begin to see how uneven the scales are.

If women in medicine are outperforming men, asking women to “be more like men” won’t solve the problem. According to one of the studies, it might be better to do the opposite: “we estimate that approximately 32,000 fewer patients would die if male physicians could achieve the same outcomes as female physicians every year.” 

As things stand, what exactly is compensation compensating?