Why women in healthcare get paid less

The numbers are new, but the issue is not: the latest US Census Bureau data, out Monday, shows female physicians and surgeons get an average salary that's only 69% of their male counterparts. There are large disparities in other healthcare fields as well, which raises the age-old question: Why?

The data of 2013 salaries also shows that female physician assistants earned, on average, 81% of the salary of their male counterparts. And it echoes other studies done in the executive suite, including a 2013-14 study done by the Diversified and the Women's Leadership Center through the Coles College of Business at Kennesaw State University. In that study, researchers found that amongst a sample size of about 275 executives across a broad range of healthcare providers, compensation for women was an average of 35% lower than for men in similar positions.

Different career paths?

The existence of the gap alone is controversial (put "gender wage gap" in Google and the first thing that the search engine suggests is "gender wage gap myth")​, so asking why is a game of political hot-potato.

Some claim that differing career paths are the culprit. Commenting in spring 2014, The Advisory Board's Katherine Virkstis addressed the wage gap in the field of nursing. (In 2013, female registered nurses outnumbered men by more than 7 to one, but men were paid on average $6,000 more.)

"Men...tend to aim for higher levels of education," Virkstis said. "There are more men in RN programs than in LPN programs, and more men in BSN programs than in RN diploma or ADN programs."

The KSU study made a similar suggestion. After finding that a significantly higher number of female executives were promoted from within their organizations while men were more likely to be recruited externally, the researchers suggested that this finding was likely related to the fact that men were more willing to relocate for their jobs than were women. (The study also found that men came from different professional backgrounds: 66% of men reported a background in medicine, finance or general administration, while 44% of women had nursing backgrounds.)

Is gender bias to blame?

Neither of these addresses the underlying cause, though these kind of stats are frequently touted as evidence that gender bias is a figment of the liberal imagination. ("Men and women simply want different things.") Why are female nurses not aiming for the same education levels as male nurses? Gender bias is notoriously difficult to prove—something that a 2012 study out of Yale and published in PNAS tried to tackle through blinded study.

Scientists were given application materials from a student applying for the position of lab manager who intended to go on to graduate school. Half of the scientists were given the application with a male name and half were given the same application with a female name. Not only were the "female" applicants ranked lower on competence, hireability and whether the scientist would be willing to mentor the student, but they were also offered significantly lower starting salaries (about $26,000 compared to $30,000 for the male applicants).

Notably, male and female subjects employed the same biased hiring practices, and both relied on professional reasoning to explain their choices—blaming competency, for example.

"If faculty express gender biases, we are not suggesting that these biases are intentional or stem from a conscious desire to impede the progress of women in science," wrote the researchers. "Past studies indicate that people's behavior is shaped by implicit or unintended biases, stemming from repeated exposure to pervasive cultural stereotypes that portray women as less competent…"

So what is really holding women back?

According to a recent survey from Rock Health, the biggest obstacles women face in climbing the healthcare ladder are self confidence, time constraints and the ability to connect with senior leadership. Particularly notable in the light of the Yale gender bias study was the 43% of respondents who said they had no mentor. An oft-cited pair of Catalyst studies found that in 2008, 78% of men were actively mentored by a CEO or another senior exec in all industries, compared to only 69% of women.

Women are also less likely than men to have sponsorship opportunities available to them, according to Victoria Pynchon, co-founder of a Los Angeles-based career consulting firm that specializes in helping women achieve better job opportunities. A sponsor, unlike a mentor, is a workplace leader who is willing to stick his or her neck out, politically, for the sake of another's career. Sponsors advocate for the advancement of a worker—and it's a tricky responsibility to take on because it involves staking one's own reputation on the performance of another. Unconscious biases can make these relationships difficult for women to form.

"There's the lingering idea that one, women are not suited for leadership because they have children and must, of course, be more preoccupied with them than a man with children would be, or two, might not 'fit in' or 'get along with' inside or outside 'stakeholders' who are still too often men who are still too often assumed to 'get along better with men than they will with women,'" Pynchon told Healthcare Dive. Women are still viewed as "risky" appointments, according to Harvard Business Review. 

Still, increased mentor and sponsorship opportunities do not necessarily resolve the problem. In the same Catalyst study, among all participants who had found mentors on their own, the men still received more promotions than the women—by a ratio of almost three to two. Among survey participants who had active mentoring relationships in 2008, 72% of the men had received one or more promotions by 2010. Only 65% of women had advanced.

"More sponsoring may lead to more and faster promotions for women, but it is not a magic bullet: There is still much to do to close the gap between men's and women's advancement," wrote organizational behavior professor Herminia Ibarra in Harvard Business Review. "Some improvements—such as supportive bosses and inclusive cultures—are a lot harder to mandate than formal mentoring programs but essential if those programs are to have their intended effects."

Want to read more? You may enjoy this feature on why women account for just a fraction of hospital CEOs.