What explains wage differences between male and female Brazilian physicians? A cross-sectional nationwide study

Professional activity and experience after a residency training program in ObGyn: A 10-year analysis

OBJECTIVE

To describe the profile and professional trajectory of the obstetrics and gynecology (ObGyn) graduates over the past decade, at a referral university hospital.

METHODS

A cross-sectional study was conducted, utilizing a survey that targeted graduates of the ObGyn residency program from the last decade, asking about demographics, medical undergraduate, residency details, post-residency trajectory, satisfaction levels, and social media usage. A descriptive analysis was performed. Comparative analyses, including gender-based differences, were assessed using chi-squared or Fisher exact tests (P < 0.05).

RESULTS

Among 126 graduates, 84 agreed to participate (66.67%), predominantly comprising females with an average age of 33 years. Most identified themselves as white. The majority had pursued their undergraduate studies at the same institution (78.6%) and subsequently acquired specialized titles in ObGyn from the national society. Most of them were employed in both public and private sectors (71.08%). Male graduates held the majority of medical shifts in obstetrics. A significant gender-based salary discrepancy was noted, favoring males. More than half of the professionals utilized social media for work-related purposes. Many expressed the necessity for supplementary education beyond public health, particularly career management.

CONCLUSION

The findings highlight a predominance of female and white individuals among the graduates. Overall, graduates expressed contentment with their education and professional engagements. A gender-based income disparity was identified, favoring male graduates. Studies like this can provide insights for improving medical residency education.

The impact of virtual negotiation training for female faculty

Purpose

We developed a virtual interactive course for female faculty/practicing physicians and trainees to hone their skills in negotiation and sought to evaluate the impact of this on their knowledge, comfort, and skill in negotiation.

Methods

We surveyed participants as to their comfort and experience with negotiation before and after the course, as well as three months later.

Results

Of the 102 participants in the faculty course, 55 (53.9%) were academic ladder faculty, and 47 (46.1%) were in surgery or a surgical subspecialty. Participants were significantly more comfortable with negotiation initiation, strategy, and post-settlement settlement after the course (p < 0.001 for each). 91.1% found the course valuable, 92.9% felt their knowledge about negotiation increased, and 85.7% wished they would have taken this course earlier. 98.2% stated they were likely to use some of the things they learned in this course in future. Three months later, 40.7% of respondents stated they had used what they had learned: 57.7, 41.7, and 32.0% had negotiated for pay, promotion, or job-related perks, respectively. These negotiations went "better than expected" in 26.6, 30, and 37.5%, respectively. Prior to the course, only 3 (2.9%) felt that their last negotiation went "very well" or better; three months after the course, 28% felt their last negotiation after the course went "very well" or "extremely well" (p = 0.002).

Conclusion

Negotiation training can have a significant impact on female physicians' comfort in initiating negotiation, negotiation strategy and post-settlement discussions. Such training significantly increases "better than expected" negotiations.

Gender differences in income among psychiatrists in China: Findings from a national survey

Background

Gender income disparity in healthcare settings is a longstanding issue around the globe, but such evidence among Chinese psychiatrists is scarce. This study investigated whether gender income differences exist among physicians in China.

Methods

Data came from the 2019 national survey data of 4,520 psychiatrists in major public psychiatric hospitals across China. Self-reported monthly income after tax (in Chinese Yuan, CNY) by participants at all professional ranks was assessed. Average monthly income by gender was reported. Adjusted income differences between male and female psychiatrists were examined using multivariable regression models, adjusting with inverse probability of treatment weights and controlling for psychiatrist demographics (e.g., gender, professional rank, marital status, educational level, and work hours) and hospital fixed effects.

Results

The unadjusted mean difference in monthly income after tax by gender was 555 CNY (about $86; 95% CI, -825 to -284; mean [SD] for men: 8,652 [4,783] CNY and for women: 8,097 [4,350] CNY) in all psychiatrists. After regression adjustments, the income difference by gender among all psychiatrists reduced substantially and became insignificant. However, gender income difference was still observed among senior-level psychiatrists, where female psychiatrists earned 453 CNY (about $70; 95% CI, -810 to -95) significantly less than male psychiatrists.

Conclusion

China achieved gender equity in income for psychiatrists overall, the observed income differences among senior level psychiatrists, however, reveal the persistence of gender inequity at the highest level of professional hierarchy. These findings call for policy attention to the issue of gender income disparity among psychiatrists in China's healthcare system.

Differential attainment and recruitment to Intensive Care Medicine Training in the UK, 2018-2020

BACKGROUND

Differences exist among doctors in examination performance, clinical and academic career progression, and prevalence of performance assessment by professional regulatory bodies. Some of these differences have been reported in relation to individual characteristics. The purpose of this study is to establish whether any specific individual characteristics are associated with performance in selection for entry into specialty training in Intensive Care in the United Kingdom.

METHODS

We evaluated data of 509 candidates from the national recruitment rounds of 2018/19 and 2019/20. The outcome evaluated was "success at interview". Variables reaching statistical significance at univariate logistic regression analysis were fed in the multivariable analysis to identify independent predictors of success, with additional exploratory analyses performed, where indicated.

RESULTS

The candidates' median age was 31.5 (interquartile range, IQR 30-33.7) years, 324 (63.7%) were male, 256 (50.3%) not married/in civil partnership, 6 (1.2%) pregnant. The majority (316, 62.1%) were White British, 99 (19.5%) of Asian background, other ethnicities represented less than 20% of the sample. Of the 509 candidates, 155 (30.5%) were Atheist, 140 (27.5%) Christian; most were heterosexual (440, 86.4%); 432 (84.9%) reported no disability, while 4 (0.8%) had a minor and 1 (0.2%) had a major disability; 432 (84.9%) candidates held a UK medical degree; 77 (15.1%) a non-UK degree. At univariate logistic regression analysis (LRA) multiple factors were found to be associated with a lower likelihood of success, the strongest being an international medical graduate (IMG, holding a non-UK medical degree); others were increasing age, male gender, being married, Asian or mixed ethnicity, specific religious beliefs (Buddhism, Islam and Hinduism). After feeding all factors significant at univariate analysis, the only two retained as independent predictors at multivariable regression were Asian ethnicity and holding a non-UK degree. Asian UK graduates success rate was 92.7%, comparable to the national average of 92.3%, the Asian IMGs success rate was significantly lower, at 45.5%.

CONCLUSIONS

As the imbalances seen within the candidates of Asian background are explained by considering the country of primary medical training, the variations in performance is likely to reflect differences in training systems and understanding of the UK NHS.

Differences in Practice Patterns and Payments for Female and Male Dermatologists: A Canadian Population-Based Study Over 3 Decades

BACKGROUND

Canada's fee-for-service physician reimbursement system, where a set rate is provided for each service, suggests that a physician sex pay gap should not exist. However, recent evidence has questioned this presumption.

OBJECTIVES

To characterize trends in demographics and billing, overall and by sex, for dermatologists compared to other medical and surgical specialty groups in Ontario, Canada.

METHODS

Using population-based data, analysis of physician billing and clinical activity from Ontario, Canada, over 27 years (1992-2018) was performed. Multilevel regression models were used to examine unadjusted and adjusted differences in payments between females and males over time, while controlling for age, distinct patients seen, patient visits, and full-time equivalent.

RESULTS

A total of 22 389 physicians were included in the analyses, including 381 dermatologists. The proportion of female dermatologists increased from 32% in 1992 to 46% in 2018. Dermatologists' median Ontario Health Insurance Plan (OHIP) payments were $415 340 (IQR: 285 630-566 580) in 1992 compared to $296 750 (IQR: 164 480-493 180) in 2018. Male dermatologists' OHIP payments were 20% more than their female counterparts across the entire study period. After adjusting for practice volumes, there was no significant pay gap amongst female and male dermatologists (P = .42); however, the sex pay gap remained significant for the other specialty groups (P < .001). From 1992 to 2018, dermatologists on average saw 19% fewer distinct patients per year and 15% fewer visits per patient.

CONCLUSIONS

The overall sex pay gap within medical dermatology can be attributed to differences in practice patterns, whereas the sex pay gap remained significant in the other specialty groups.

Women in Medicine: The Limits of Individualism in Academic Medicine

In the 21st century, more than ever before, issues facing women in medicine, such as pay equity and workplace harassment, are being explored and attended to by physicians and health care institutions. Discussions about women in medicine almost exclusively center around women physicians, even though most women in medicine are, in fact, not physicians. In addition, these discussions typically focus on gender, often failing to consider how race, class, and other dimensions of identity influence the experiences of women in medicine. In this article, the authors argue that neoliberal feminism is the dominant strand of feminism in the discourse of women in medicine. With its focus on the individual and a conception of success defined in largely economic terms, neoliberal feminism fails to consider the broader conditions in which women are situated and, therefore, limits structural criticism and the possibility for all women to engage in social justice. The authors suggest that the pandemic is an opportunity to pursue a more expansive vision of feminism in medicine. They propose intersectional feminism as a theoretical framework that can widen the understanding of what is possible: moving from individual actions resulting in incremental change to collective action that can transform systems. Intersectional feminism enables a push for structures, institutions, and practices that support all workers, including basic income, labor protections, public childcare, accessible health care, transportation justice, and migrant rights. In so doing, intersectional feminism calls for solidarity with and among women both within and outside of medicine.

Impacto da Percepção de Suporte Organizacional e Capital Psicológico no Bem-Estar no Trabalho

Resumo Este estudo teve por objetivo testar um modelo no qual o bem-estar no trabalho (BET) é explicado pela percepção de suporte organizacional e capital psicológico. Trata-se de estudo quantitativo, corte transversal e correlacional, no qual a amostra foi composta por 227 trabalhadores, sendo a maioria do sexo feminino (57,7%), na faixa etária de 29 anos e com prevalência de curso superior incompleto e completo representando 65,2% dos participantes. A maioria atua na iniciativa privada (68,3%) e não ocupa cargo de chefia. Foram utilizados instrumentos fidedignos e com índicio de validade relativos aos construtos investigados. Para análise de dados, utilizaram-se estatística descritiva, testes de comparação de médias (Teste t e ANOVA) e análise de regressão múltipla (método padrão). Entre os resultados, identificou-se que otimismo, autoeficácia/esperança (capital psicológico) e a percepção de suporte organizacional são variáveis explicativas das vivências de BET. Portanto o modelo não foi confirmado na íntegra, pois resiliência não apresentou relações significativas com bem-estar. Além disso, somente otimismo revelou poder explicativo sobre afetos positivos, afetos negativos e realização (dimensões de BET). Destaca-se que capital psicológico demonstrou maior peso na predição de BET que percepção de suporte organizacional, exceto no caso de afeto negativo. Os resultados indicam que tanto variáveis individuais quanto variáveis contextuais são importantes para explicar a prevalência de BET.

Sex Differences in the Pattern of Patient Referrals to Male and Female Surgeons

Importance

Studies have found that female surgeons have fewer opportunities to perform highly remunerated operations, a circumstance that contributes to the sex-based pay gap in surgery. Procedures performed by surgeons are, in part, determined by the referrals they receive. In the US and Canada, most practicing physicians who provide referrals are men. Whether there are sex-based differences in surgical referrals is unknown.

Objective

To examine whether physicians' referrals to surgeons are influenced by the sex of the referring physician and/or surgeon.

Design, Setting, and Participants

This cross-sectional, population-based study used administrative databases to identify outpatient referrals to surgeons in Ontario, Canada, from January 1, 1997, to December 31, 2016, with follow-up to December 31, 2018. Data analysis was performed from April 7, 2019, to May 14, 2021.

Exposures

Referring physician sex.

Main Outcomes and Measures

This study compared the proportion of referrals (overall and those referrals that led to surgery) made by male and female physicians to male and female surgeons to assess associations between surgeon, referring physician, or patient characteristics and referral decisions. Discrete choice modeling was used to examine the extent to which sex differences in referrals were associated with physicians' preferences for same-sex surgeons.

Results

A total of 39 710 784 referrals were made by 44 893 physicians (27 792 [61.9%] male) to 5660 surgeons (4389 [77.5%] male). Female patients made up a greater proportion of referrals to female surgeons than to male surgeons (76.8% vs 55.3%, P < .001). Male surgeons accounted for 77.5% of all surgeons but received 87.1% of referrals from male physicians and 79.3% of referrals from female physicians. Female surgeons less commonly received procedural referrals than male surgeons (25.4% vs 33.0%, P < .001). After adjusting for patient and referring physician characteristics, male physicians referred a greater proportion of patients to male surgeons than did female physicians; differences were greatest among referrals from other surgeons (rate ratio, 1.14; 95% CI, 1.13-1.16). Female physicians had a 1.6% (95% CI, 1.4%-1.9%) greater odds of same-sex referrals, whereas male physicians had a 32.0% (95% CI, 31.8%-32.2%) greater odds of same-sex referrals; differences did not attenuate over time.

Conclusions and Relevance

In this cross-sectional, population-based study, male physicians appeared to have referral preferences for male surgeons; this disparity is not narrowing over time or as more women enter surgery. Such preferences lead to lower volumes of and fewer operative referrals to female surgeons and are associated with sex-based inequities in medicine.

Liderança feminina: relato do primeiro encontro de mulheres Médicas de Família e Comunidade do Brasil

RESUMO Este relato situa-se no campo do protagonismo das mulheres Médicas de Família e Comunidade (mMFC) e em sua articulação nacional por meio do Grupo de Trabalho Mulheres na Medicina de Família e Comunidade (GT-MMF), fundado em 2016 no bojo da Sociedade de Medicina de Família e Comunidade (SBMFC), entidade científica que representa a especialidade no País. Descreve a organização do I Encontro do GT-MMFC, em 2019, intitulado ‘Liderança feminina em saúde’ e discute seus desdobramentos, com foco na equidade de gênero nos domínios: profissional, acadêmico, de gestão, de ensino e pesquisa; assim como na própria instituição, a SBMFC. O artigo se debruça, ainda, sobre questões relacionadas com as causas de mulheres no âmbito da especialidade e da medicina. O evento foi aberto a estudantes e profissionais de outras áreas e ofertou discussões contemporâneas, como: protagonismo feminino; autocuidado; interseccionalidades; maternidade e trabalho; inserção da mulher e diferenças de gênero na política. O Encontro reuniu mulheres de quatro regiões do Brasil, aprofundou as relações e o apoio interpares e permitiu a ampliação das pautas para o fortalecimento da consciência de gênero e sua influência no cotidiano das mMFC, na sua prática acadêmica, científica, assistencial e de gestão.

The gender pay gap in medicine: A systematic review

BACKGROUND

Women are becoming doctors in greater numbers. Despite this, there is evidence of female doctors' continued differential treatment compared to their male counterparts.

PURPOSE

The aim of this study was to review systematically the extant literature on the gender-based pay gap in medicine across time, different medical specialties, and different countries of clinical practice.

METHODS

Systematic search of three databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies needed to be empirical and contain either an unadjusted or adjusted gender-based finding related to pay.

RESULTS

A total of 46 articles published since 2000 contained a gender-based finding related to physician pay. Thirty-two of these 46 articles presented either adjusted or unadjusted means comparisons (or both) comparing pay between male and female physicians. Eighteen of the 46 articles controlled for one or more variables in examining pay between the two groups. Across almost all studies, female doctors earn significantly less than men, often tens of thousands of dollars less annually, despite similar demographic and work-related profiles. This earnings gap is persistent across time, medical specialty, and country of practice.

PRACTICE IMPLICATIONS

The gender-based pay gap is an ongoing crisis within medicine that must be addressed. From a practice perspective, women physicians may benefit from greater organizational awareness of potential workplace bias and the implementation of more supportive policies aimed at better equalizing compensation through greater support and transparency related to salary negotiations, promotional opportunities, and pay scales across various job titles.

The gender wage gap among medical specialists: a quantitative analysis of the hourly pay of publicly employed senior doctors in New Zealand

OBJECTIVES

To estimate the gender gap in hourly wages earned by medical specialists in their main jobs after controlling for age, number of hours worked and medical specialty.

DESIGN

Observational using governmental administrative and survey data.

SETTING

New Zealand public employed medical workforce.

PARTICIPANTS

3510 medical specialists who were employed for wages or a salary in a medical capacity by a New Zealand district health board (DHB) at the time of the March 2013 census, whose census responses on hours worked were complete and can be matched to tax records of earnings to construct hourly earnings.

MAIN OUTCOME MEASURES

Hourly earnings in the DHB job calculated from usual weekly hours worked reported in the census and wage or salary earnings paid in the month recorded in administrative tax data.

RESULTS

In their DHB employment, female specialists earned on average 12.5% lower hourly wages than their male counterparts of the same age, in the same specialty, who work the same number of hours (95% CI 9.9% to 15.1%). Adding controls for a wide range of personal and work characteristics decreased the estimated gap only slightly to 11.2% (95% CI 8.6% to 13.8%). At most, 4.5 percentage points can be explained by gender differences in experience at the same age.

CONCLUSIONS

Male specialists earn a large and statistically significant premium over their female colleagues. Age, specialty and hours of work do not appear to drive these wage gaps. These findings suggest that employment agreements that specify minimum wages for each level of experience, and progression through these levels, are insufficient to eliminate gender wage gaps between similar men and women with the same experience.

Religiosity and Spirituality of Resident Physicians and Implications for Clinical Practice-the SBRAMER Multicenter Study

OBJECTIVES

To assess the attitudes, knowledge, and experiences of Brazilian resident physicians regarding religiosity/spirituality (R/S), factors associated with addressing this issue, and its influence on clinical practice.

METHODS

We report results of the multicenter "Spirituality in Brazilian Medical Residents" (SBRAMER) study involving 7 Brazilian university centers. The Network for Research Spirituality and Health (NERSH) scale (collecting sociodemographic data, opinions about the R/S-health interface, and respondents' R/S characteristics) and the Duke Religion Index were self-administered. Logistic regression models were constructed to determine those factors associated with residents' opinions on spirituality in clinical practice.

RESULTS

The sample comprised 879 resident physicians (53.5% of total) from all years of residency with 71.6% from clinical specialties. In general, the residents considered themselves spiritual and religious, despite not regularly attending religious services. Most participants believed R/S had an important influence on patient health (75.2%) and that it was appropriate to discuss these beliefs in clinical encounters with patients (77.1%), although this was not done in routine clinical practice (14.4%). The main barriers to discussing R/S were maintaining professional neutrality (31.4%), concern about offending patients (29.1%), and insufficient time (26.2%). Factors including female gender, clinical specialty (e.g., internal medicine, family medicine, psychiatry) as opposed to surgical specialty (e.g., surgery, obstetrics/gynecology, orthopedics), having had formal training on R/S, and higher levels of R/S were associated with greater discussion of and more positive opinions about R/S.

CONCLUSION

Brazilian resident physicians held that religious and spiritual beliefs can influence health, and deemed it appropriate for physicians to discuss this issue. However, lack of training was one of the main obstacles to addressing R/S issues in clinical practice. Educators should draw on these data to conduct interventions and produce content on the subject in residency programs.

Characteristics of Heart Failure Trials Associated With Under-Representation of Women as Lead Authors

BACKGROUND

Clinical trials change practice in cardiology, and leading them requires research training, mentorship, sponsorship, and networking. Women report challenges in obtaining these opportunities.

OBJECTIVES

The purpose of this review was to evaluate temporal trends in representation of women as authors in heart failure (HF) randomized controlled trials (RCTs) published in high-impact medical journals and explore RCT characteristics associated with women as lead authors.

METHODS

We searched MEDLINE, EMBASE, and CINAHL for HF RCTs published in journals with an impact factor ≥10 between January 1, 2000, and May 7, 2019. We assessed temporal trends in the gender distribution of authors, and used multivariable logistic regression to determine characteristics associated with women as lead authors.

RESULTS

We identified 10,596 unique articles, of which 403 RCTs met inclusion criteria. Women represented 15.6% (95% confidence interval [CI]: 12.2% to 19.6%), 12.9% (95% CI: 9.8% to 16.6%), and 11.4% (95% CI: 8.5% to 14.9%) of lead, senior, and corresponding authors, respectively. The proportion of women authors has not changed over time. Women had lower odds of lead authorship in RCTs that were multicenter (odds ratio [OR]: 0.58; 95% CI: 0.18 to 0.96; p = 0.037), were coordinated in North America (OR: 0.21; 95% CI: 0.08 to 0.70; p = 0.011) or Europe (OR: 0.33; 95% CI: 0.09 to 0.91; p = 0.039), tested drug interventions (OR: 0.42; 95% CI: 0.16 to 0.97; p = 0.043), or had men as the senior author (OR: 0.50; 95% CI: 0.21 to 0.93; p = 0.043).

CONCLUSIONS

Women are under-represented as authors of HF RCTs, with no change in temporal trends. Women had lower odds of lead authorship in RCTs that were multicenter, were coordinated in North America or Europe, tested drug interventions, or had men as senior authors.

Carta de Cuiabá - Mulheres, Médicas de Família e Comunidade, no Brasil

Este artigo é um breve relato histórico sobre a formação do Grupo de trabalho de Mulheres na Medicina de Família e Comunidade da SBMFC (GT-MMFC), que ocorreu em 2016. Em paralelo, descreve-se as principais ações do Wonca Working Party on Women & Family Medicine e do próprio GT-MMFC até os dias atuais. Os objetivos do artigo são registrar a construção deste grupo de trabalho assim como fomentar e fortalecer o debate de todas as dimensões relacionadas às mulheres e a medicina de família e comunidade e a equidade de gênero.