Friday, February 25, 2011

Can Seven Comments Help Explain $17,000?

Update: Now on the Hastings Center Bioethics Forum.

A study this month in Health Affairs found that the gender pay gap for starting physicians had widened from $3600 to nearly $17,000 over the last ten years (after adjustments for specialty and hours worked).  The authors hypothesized that the main reason for this was that women are intentionally choosing lower-paying jobs because these jobs provide greater flexibility and family-friendly benefits.  Though they do not deny that gender discrimination may exist, they have doubts that it has gotten worse in the last decade.

" would be difficult to believe that discrimination, after a period of quiescence, has actually been on the rise in recent years," they write.

I do not know if gender discrimination is on the rise.  I do believe it is still a major problem in the medical community.  I have taken flak for this perspective, and I have elicited considerable backlash.  But, I present the content of these reactions as evidence of the problem. 

I am a student blogger for Medscape's The Differential, a community composed of medical students and residents around the world.  In other words, these are the people who will eventually be our colleagues and employers.

I wrote a post on Medscape linking to my analysis on this blog, as well as adding few anecdotes.

I received the lowest average rating I have ever gotten for a post.

I also received comments (36 total, discounting my own).  I have excerpted seven of them.  Six of them were within the first eight responses to my post.

Right off the bat (comment #1), a commenter argued that gender discrimination was logical.  Why?
"If a male and female both apply for an important position (suppose, a physician at a hospital, or CEO of a large company) and they have the exact same qualifications, and perform exactly as well as each other in the interview, (and seeking the same salary, if this is negotiable)...
As the employer, who would you hire?
For a female, the opportunity cost of childbearing (i.e. working for your hypothetical hospital / company) represents a huge loss of utility for you, the employer. She would be unable to work during the final 6 weeks of her 40 week gestation (and will most likely have maternity leave for much longer than that). Furthermore, the hormonal and mechanical factors of childbearing will greatly reduce her ability to perform at her best during weeks 28-34 of gestation (e.g. going to the toilet every 30 seconds)." 
 [Later on, this same poster added:
"- The employer has the right to decide his (or HER) own strategy for choosing the "BEST" candidate. This is what I believe a rational employer MIGHT do (for a position such as a physician or a CEO):
- If a male and female candidate had the SAME qualifications, SAME interview performance, and are negotiating for the SAME salary - and everything else is equal - then without further information (about future childbearing status), I would DEFINTELY choose the man. (Because they have equal likelihood of having a child, but if/when it happens the woman will require more time off work).
- If I knew the female had a Tubal ligation (but I am clueless about when/if the man intends to father a child) then I would DEFINTELY choose the female. (i.e. I am choosing the "sure thing" over a risk)
- If I knew that neither of them intended to start a family, then I would be INDIFFERENT."] 
Some commenters agreed with this biological rationale:
"I'm not saying sexism doesn't exist, but like the first commenter... intelligently said I believe this difference in pay check has more to do with pregnancy and the inevitable loss of money and utility for the company than anything else.... After all, if equality is what you are looking for, you can not work less than a man and expect the same pay check just because you are a woman. So, because of the biological diferences between men and women, I think job opportunities, salaries, roles, and available activities for both men and women will never be totally equal, and that has nothing to do with sexism but biology." [Comment #2]
"I think the only way a woman (or a man, for that matter, if the idea of paternal leave is a policy) could demand equal payment with the other sex is to prove that they are incapable of having children....which is fairly extreme. I'm very sensitive to the equality of women, but we must also be careful about 'overswinging' the pendulum." [Comment #8]
Other commenters questioned behaviors of women:
"There are dozens, literally, of other factors that congtribute to salaries in addition to simply hours worked. It is the misunderstanding of this issue, or the failure to recognize the true nature of this issue, then causes people to scream sexism... Of course there are those people who want to see sexism every where because it helps explain their own lesser position." [Comment #6]
"Here is my question for the self-titled "hyperfeminist", sexual organs aside, do you believe that men and women are different?  If not, I have no further comment. If so, do these characteristics differences translate to some sort of difference in their ability to perform work?"  [Comment #32]
Still other commenters argued that discrimination did not exist or that women were actually being favored:
"Men are judged solely on how much money they make and therefore work harder to make more money. Women are not judged solely by their salaries and numerous studies that are not ideologically biased have shown that women make different choices in where they study, what they study, how long they study, what extra work they do, etc that all explains the gender gap in salaries. Work done by Professor Stephen Cole at SUNY Stony Brook shows that there has not been gender bias in medicine since the 18th century... look at med school admission rates that far back and it has been proven."  [Comment #4]
"I completely agree, after reading this article I feel that these feminist views further support my belief that no matter how equal job opportunities, salaries, roles, etc becomes, certain women will never be satisfied. I feel "Hyperfeminists" are the reason why some men make sexist jokes or feel that women are treated unfairly well (i.e. admission into higher education is highly favorable for women at this time)." [Comment #3]
I am disturbed by the immediate responses for two reasons: 1) the community they come from, and 2) the fact that comments are fairly thought-out and presented as logical, non-sexist perspectives.

Commenters believe that it is legitimate to discuss average differences between two groups (males and females); I do not disagree.  

But when does a preference for particular individuals constitute an "ism" (which we have laws against)?  As the original poster pointed out:
"You want to hire a junior doctor at the local hospital. Two candidates - Andrew and Brett, are applying. They came from the same medical school, with the same marks, and perform equaly well on the interview. They desire the same, fixed salary. 
During the interview, you are impressed that Andrew is an extremely talented violinist in his spare time... and you are equally impressed that Brett is an extremely talented vert-ramp skater (i.e. "skateboarder").
However, Brett reveals "I am very passionate about my skating, and don't think I will stop any time soon. I'm always very careful, but there is a 50% chance that I'll have a fractured tibia in the next 10 years. It's a risk that I'm willing to take, and life is all about risk - however it means I might be out of action for 4 months".
Moral question: is it fair to choose Andrew over Brett for this reason alone? (All else equal)."

The obvious point the poster is trying to make is that yes, in this case, the discrimination is fair.  I would like to distinguish employer judgement in a hiring decision in a particular instance from an "ism," though.

In my opinion, an "ism" that should not exist occurs after a few criteria have been satisfied:

1) When group generalities become rules for individuals--e.g., in who to hire and how much to pay them.

2) When individuals have no control over the group to which they belong.

3) When one cannot (or reasonably be expected to) hide the group to which he or she belongs.

4) When it is nearly impossible to predict how an individual will do the job based on the group he or she belongs to.

Where it gets sticky, of course, is where to draw the line.  Gender, race, height, weight, religion, age, health.  The list goes on.  And what about certain professions with different standards?  At what point can employers choose their workforce without being accused of an "ism"?  

I don't pretend to have all answers for all situations, and so I am narrowing my scope to gender in medicine.  The aforementioned comments, I believe, constitute a form of sexism.

Commenters claim their views are grounded in the economic model we work within. That is fair, but--wrongly, I believe--there is nothing said of the normative, or "what ought to be."  Without this consideration, there is no impetus to address existing inequalities on a larger scale.

Later on, one commenter summed it up particularly well:
"Reading this thread I am impressed by the amount of tacit sexist comments and thoughts made by supposedly intelligent, 'progressive' students. I think it partly explains why we see this widening of the gap- just bringing up the idea of gender equality elicited such responses as, "we must also be careful about 'overswinging' the pendulum," (um, aren't we talking about how we're actually moving in the opposite direction?), and "there are those people who want to see sexism every where because it helps explain their own lesser position" (the entitlement of this comment makes me nauseous). Even more troubling is that these students seem to lack the awareness of how their comments come across, as if they wouldn't consider themselves sexist in the first place. I'm grateful to see some responders on here that seem as equally appalled as I, but the ratio of ignorant sexist comments to intelligent ones is disheartening."
Perhaps comments only select for the most vocal opponents.  But these are their attitudes, and one day they will be choosing our starting salaries.


  1. Hi Shara,

    I had a very similar experience writing about this issue on my blog and having it cross-posted to KevinMD. As every detail of the study got attacked or turned over to somehow devalue the claim of sexism, I wondered whether I had not written my post clearly enough or if there was something wrong with the community drawn to that blog. But reading your comments, I see that my self-consciousness about my own blog posts was clearly not the case.

    This attitude of wanting to explain away sexism is endemic to the medical community -- a combination of skepticism and a general tendency to want to deny wrongdoing. I really, truly do not know what a few voices that see this trend can do about it, and that really, deeply frustrates me. I wonder what techniques we can borrow from women in other professions that are hitting glass ceilings?

    Looking forward to continuing this discussion,

  2. Hi Emily,

    I could not agree more. Your post was far tamer than mine, too.

    These sorts of attitudes probably make many women want to withdraw from engaging in the discussion for fear of being labeled or having their concerns trivialized. That's exactly what we shouldn't do. We are the ones who are precisely in the position to write/speak out as vehemently as we can. And eventually--when we have some degree of power--to try to change practices.

    Many of my friends agree. I assure you, we are not alone. (We just have publicly unpopular positions.)


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  4. I'm not part of the medical field but I think all this concern re 'isms', sexism in this case, in so many venues comprises simple whining and is socially very debilitating, indeed it's emblematic of what modern society has become. It's pretty disgusting. Just do the best you can with what you have and stop the incessant complaining.

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