Although overall salaries for physicians are on the rise, the wage gap between men and women physicians remains firmly in place, according to the Medscape Female Physician Compensation Report 2022: Trying to Narrow the Gender Gap. This marked difference in earning potential for women in medicine puts a spotlight on nonmonetary forms of compensation that are available as part of job packages — benefits such as paid time off, vacation, childcare offerings, flexibility, and funds for career advancement.
But these perks only go so far in enticing women physicians to positions where their male counterparts may have a higher salary.
“Everything is money, of course,” says Haneme Idrizi, MD, a pediatric hospitalist for almost 16 years and the associate dean for student affairs and admissions at Southern Illinois University (SIU) School of Medicine, in Springfield. “And how you view these benefits depends on where you’re coming from.”
Idrizi, a first-generation American, is also a member of the American Medical Women’s Association (AMWA), an organization focused on advancing women in medicine and equity advocacy. She says her journey to becoming a doctor colors her perspective on job compensation.
“Salary has always been key for me,” she says. “I am the primary breadwinner in my family, working multiple jobs to pay for college and paying for my own medical school, so I’m coming in with a different perspective that I need to support my family. The other stuff, like money for moving expenses, makes the transition from one job to the next possible. But for me personally, how much you’re going to pay me is the most important thing.”
Here is a snapshot of a few of the more common nonmonetary incentives available for physicians and what today’s women in medicine think about nonmonetary compensation.
Career Advancement Expenses
It’s standard practice for employers to cover costs that stem from the licensure and continuing medical education required of healthcare professionals. Doing so for all employees, regardless of sex, promotes equity in career advancement, especially when those benefits cover opportunities that promote movement toward leadership positions.
“Sometimes when you’re a woman in medicine — or a mother in medicine — people assume that just working is enough and you don’t necessarily want to progress or learn leadership skills, but that’s not necessarily true,” says another AMWA member, Tiffany Bell Washington, MD, MPH, quadruple-board-certified psychiatrist and lifestyle/obesity medicine specialist.
Mary Zupanc, MD, professor in the Department of Neurology at the University of Wisconsin–Madison, relates. She has been a practicing pediatric neurologist since the 1970s and has seen a sizable shift in physician demographics, but she notes that this shift isn’t yet reflected in medicine leadership.
“There were 25 women in my class at UCLA medical school, and it was the largest class of women they’d ever had,” she says. In comparison, in 2019, 53.5% of applications to MD-granting medical schools came from women, and women made up 53.7% of the number of students matriculating, according to the American Medical Association.
“And yet if you look at the number of deans of medical schools, division chiefs, department chairs, there’s not parity there,” says Zupanc.
She says promotions also lag behind, especially for women who have children. This means the opportunity to advance often passes them by. As a result, chances to grow in leadership — through compensated leadership conferences and certifications — are crucial.
“I think there’s still this unconscious bias that women are not really serious about their career, so they don’t necessarily get promoted as quickly,” says Zupanc. “The junior faculty I mentor are thinking about this all the time — how to really achieve this good work-life balance.”
A 2019 study in JAMA Network Open showed that a substantial number of women physicians in various specialties at all levels of training across the US needed and wanted more support for parental leave and return to work.
The needs included support at the institutional level, such as paid leave, adequate breast pumping time without penalty, and on-site childcare.
“One of my surgical colleagues, when I was on faculty at Harvard Medical School, did an interesting study looking at the complications tied to pregnancy and childbirth in women in medicine relative to women in the general population, and it found that they’re almost double,” says Anju Patel, MD, an otolaryngologist specializing in head and neck surgery, who is associate medical director at Mytonomy, a health technology company that focuses on patient education.
“And when we look at certain complications, infertility is double in women in medicine relative to the general population,” says Patel. That shows that women may be more taxed physically and that they may be more vulnerable in comparison with the general population, which is underestimated regarding parental leave, Patel adds.
Idrizi says that she has seen more male colleagues turn their attention to parental leave than in the past, but she also notes that leave has a different value when recovery is involved.
“I had three C-sections, and so I needed that time to heal more than anything else,” she says. “But I do think that males are seeing the value of it more and more.”
In the wake of the COVID-19 pandemic, the need for schedule flexibility has become paramount. Opportunities for telehealth and creative office hours matter more than ever.
AMWA board of directors member Susan Thompson Hingle, MD, calls schedule flexibility the “most important nonfinancial incentive.” Hingle also serves as associate dean for human and organizational potential and director of professional development in the Department of Medicine at SIU School of Medicine.
“The mindset that as long as high-quality work gets done, it doesn’t matter when or where it gets done — that’s important,” she says.
Patel notes that in addition to parental leave policies, job security in the face of schedule changes plays a significant role in determining the position that fits her best.
“In my current position, I have unlimited paid time off, which is huge when you have two young children, especially in cold and flu season,” she says. “Having that flexibility is invaluable.”
Bottom Line: Salary Equity Matters
Idrizi points out that even nonmonetary benefits often have to be negotiated, and women are more often at a disadvantage in that arena than men because they often don’t negotiate and therefore tend to have less practice doing so.
“I feel like women, in general, are more scared to bring up these topics than men,” says Idrizi. “I have needed this many years of experience to gain the courage and the confidence to even bring it up.”
No matter how valuable certain incentives are, the salary gap between women and men remains an imbalance that colors the medical profession.
“In my experience, the nonmonetary benefits or compensation matter the most when at least the pay is equitable,” says Washington. “So if I’m in a situation where I am clearly being paid below market value, and I know for sure they’re offering other people higher salaries, then there are probably not that many nonmonetary benefits they can offer that would sway me.”
Rachel Reiff Ellis is an Atlanta-based freelance writer and editor specializing in health and medicine. She is a regular writer for WebMD and Fortune Well, with additional work appearing in Prevention, Oprah Magazine, Women’s Health, Good Housekeeping, Country Living, and Women’s Day. She regularly contributes as a patient-advocate profile writer to Global Healthy Living Foundation, a nonprofit organization whose mission is to improve the quality of life for people living with chronic illnesses.