If you were an economist it seems like emergency medicine would be a great field to examine pay equality- after all we all do shift work. Yet, unfortunately even in our world, pay data is rarely “clean.” There are a lot of different ways in which we get paid: hourly rate, salaried, RVU based, incentive based etc.  And that’s before you throw in shift differentials, seniority, regional variability, partnerships, bonuses and non-clinical responsibilities. Apples to apples comparisons are difficult.  In 2010 Robeznieks  reported on a Modern Health Care survey that the average salary for emergency medicine physicians varied from $239,000- $316,000.  That’s a pretty big range.

I remember the first time that I was hit with the reality that two people working side by side, literally doing the exact same job, could actually get paid differently. Several years ago I was in a departmental meeting in which a headhunter consecutively paged me and a male colleague out of the meeting to try and recruit us to fill shifts at a nearby hospital that had just changed contracts. Although we both said no, as we were leaving the meeting my colleague (who had far less professional experience) made a comment about the generous rate they were offering- his number was 50 dollars higher per hour than the one I was quoted. Big light bulb moment.

Fortunately, there has recently been some real momentum at the national level to try and address gender pay differences. This month the White House announced a voluntary program called The Equal Pay Pledge in which they publically challenged companies to annually review their pay scales along with their hiring and promotion policies to better identify and then correct any gender disparities.   

“We believe that businesses must play a critical role in reducing the national pay gap. Towards that end, we commit to conducting an annual company-wide gender pay analysis across occupations; reviewing hiring and promotion processes and procedures to reduce unconscious bias and structural barriers; and embedding equal pay efforts into broader enterprise-wide equity initiatives. We pledge to take these steps as well as identify and promote other best practices that will close the national wage gap to ensure fundamental fairness for all workers.”

The following are the first 28 companies who have taken the pledge: pledge: Accenture, Airbnb, Amazon, American Airlines,  BCG,  Buffer,  Care.com,  CEB, Cisco, Deloitte, Dow, Expedia, Gap, Glassdoor, GoDaddy, Jet.com,  Johnson & Johnson, L’Oreal, PepsiCo, Pinterest, Popcorn Heaven, Rebecca Minkoff, PWC, Slack, Spotify, Staples, Stella McCartney.

So what can we as emergency medicine physicians do to keep this issue moving forward and to facilitate professional equity amongst talented men and women. Here are two suggestions:

  • Consciously leverage our purchasing power.  Our salaries put us in a privileged minority and we can use our dollars to send a strong message to businesses that if they are willing to invest in smart policies than we are willing to invest in them. Please consider using the services and products of the companies listed above.
  • Start the discussion about transparent pay in your own shop*. Unfortunately, we know that several factors including unconscious bias and gender differences in negotiation (along with gender differences in the real possible consequences of negotiation) can still result in significant differences in take home pay between men and women even within our hallowed halls of medicine.  

A recent article in JAMA Internal Medicine by Jena et al highlights this reality. This study examined salary data at 24 public medical schools and found that the average female physician still makes about 20,000 less than her average male colleague even after adjustment for multiple factors including age, clinical billing and academic productivity.

Ok, most of us likely did not choose our current job based on salary alone, but at our current jobs, shouldn’t we be paid on par with our male colleagues who have similar experience and are doing essentially the same work? Hopefully, the majority of us already are but until there is wider availability of real salary transparency, it is certainly hard to say for sure.  

As a collective group it’s time to advocate for taking pay off the taboo topic list and beginning frank conversations within our groups about compensation. A good place to start is sharing the new paper on Best Practices to Recruit and Advance Women in EM with your group leadership. And next, who knows an Equal Pay Pledge for EM??

*The one caveat to this is that some contracts specifically forbid pay discussion (fixing that is a whole different can of worm).