CMAJ: Closing the gender pay gap in Canadian medicine


Originally posted by the Canadian Medical Association Journal

By Michelle Cohen and Tara Kiran

 

KEY POINTS

  • Women in Canadian medicine consistently earn less than men.

  • The pay gap between women and men exists within every medical specialty and also between specialties, with physicians in male-dominated specialties receiving higher payments.

  • The gender pay gap in medicine is not explained by women working fewer hours or less efficiently but, rather, relates to systemic bias in medical school, hiring, promotion, clinical care arrangements, the fee schedule itself and societal structures more broadly.

  • Actions for closing the gap include anti-oppression training, challenging the hidden curriculum in medical education, fair and transparent hiring and referral processes, changing the relative value of fee codes and transparent reporting of physician payments stratified by gender.

The gender pay gap, defined as the difference between what men and women earn for roughly equivalent work, has remained a core challenge in employment equity despite decades of activist effort and the substantial movement of women into the workplace. The Canadian government is taking steps to address the issue broadly, but there has been little action thus far from health care leadership to address pay equity within the medical profession. In this article, we summarize evidence on the gender pay gap in medicine in Canada and abroad, and discuss common myths, likely root causes and possible solutions. We start with the premise that equal pay for equal work is a matter of fairness and is necessary for the profession to move from aspirations of gender inclusion to equity and justice for women. Gender is not binary; however, we focus on differences in pay between groups defined in the data as men and women. Currently, there is little research on the experiences of nonbinary physicians. In the broader Canadian workforce, the pay gap is larger for women who are Indigenous, racialized or newcomers, or are living with a disability. However, there are few comparable data in medicine, and discussing how the intersection of different identities may affect pay disparity is beyond the scope of this article.


Conclusion

Women continue to be paid less than men in medicine. The gender pay gap exists within every specialty and also between specialties, with physicians in male-dominated specialties receiving higher payments. The gap is not explained by women working less but, rather, relates more to systemic bias in medical school, hiring, promotion, clinical care arrangements, mechanisms used to pay physicians and societal structures more broadly. Progress in Canada will require a commitment from medical associations and governments to close the pay gap, starting with transparent reporting of physician payments stratified by gender. We need to go further as a profession to understand how gender, race, disability and other identities intersect to affect gaps in pay and then take action to address these gaps to realize the vision of pay equity for all in medicine.

 

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