By Nisha Mehta, MD
Ask a group of early-career female physicians what their most pressing concerns about life in medicine are, and an overwhelming percentage will mention the challenge of balancing their personal and professional lives.
Many women feel the pressure to consider these factors as early as medical school, where disproportionately to male medical students, female medical students will seek out specialties that ostensibly offer more part-time options or flexibility. This can affect their decision to go into procedurally oriented specialties, which tend to offer higher compensation. In fact, looking at the highest paid specialties, females are clearly underrepresented in not just the surgical specialties, but also procedure-oriented internal medicine specialties such as cardiology and gastroenterology..
Interestingly, but perhaps not surprisingly, though male physicians are increasingly citing a need for work-life balance to enhance career longevity, they are much less likely to place as much weight on this early on. If a change is made, it is likely to be much later in their careers.
One factor in this difference may be that female physicians are statistically more likely to be dating or married to other high-income professionals when making their career decisions. These women often consciously – or unconsciously – tend to take into account the demands of their significant other’s career as they consider their own choices. If a female physician elects to work where her spouse has an established job or favorable job opportunity, her personal market is inherently limited. Prospective employers are often aware of her self-imposed geographic limitations and may use this knowledge to their advantage. When childcare responsibilities and the need for flexibility are also on the negotiating table, a woman’s power to advocate for more favorable compensation is further eroded.
The need for professional support from others, which enables the flexibility needed to address family responsibilities, also significantly hinders many female physicians from starting or joining private practices, where the earnings potential is higher. With staff positions, there is a larger pool of physicians to share call responsibilities or mechanisms for time off and last-minute coverage, but the employer takes a larger share of the revenue that they generate.
To be clear, there are many factors that go into the gender pay gap above and beyond the factors above. A female physician for which none of the factors discussed in this piece apply will still be paid less on average than a male physician. More salary transparency and real systemic change will be needed to address these issues.
As her career progresses, the high achiever that lives within most female physicians extends her drive beyond the professional space. In the first decade and a half of practice, the desire to excel in motherhood, marriage and friendships weighs heavily on female physicians. In fact, 40 percent of female physicians decide to either cut back on the hours they work or leave medicine entirely within their first six years of practice. Often, these choices are accompanied by the decision to decline – or give up entirely – on partnership or leadership positions, which, of course, offer stronger compensation packages as well as passive-income streams and profit-sharing options.
Interestingly, at later stages of their career, the concerns female and male physicians cite regarding the need to balance their work and professional lives become more similar, and women are less likely to decline opportunities based on these factors after the first decade of practice. In fact, many express regrets at overemphasizing concerns about family responsibilities and relationships in their earlier decision making. In retrospect, they feel they should have approached their choices differently and are confident that they would have found solutions to perceived problems.
While every woman in medicine could tell stories of the dilemmas they have faced, there are also many inspiring stories of how female physicians have shattered stereotypes and thought outside the box to address these issues and have fulfilling careers. This emphasizes the need for strong mentorship across generations of women in medicine, and the need for more honest discussions about these topics. Empowering female physicians to pursue both personal and professional satisfaction is key to both career longevity and ensuring a sustainable physician workforce..
Nisha Mehta, MD
A radiologist, keynote speaker, writer, and physician advocate. Her missions include addressing the physician burnout epidemic through physician empowerment and cultural change in medicine, as well as increasing business and financial literacy amongst physicians in order to promote career longevity and career satisfaction. She is a strong proponent of creating physician communities to achieve these goals, with over 100k members in her online communities, Physician Side Gigs and Physician Community. Her work has been featured in numerous international media outlets, including Forbes, CNN, the Washington Post, Bloomberg, and PBS NewsHour, as well as several prominent physicianfocused outlets. She was named a 2020 Top Voice in Healthcare by LinkedIn. She lives and works in Charlotte, NC, with her husband, who is a plastic surgeon, and her two sons.
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