Gender Differences in Earnings of Early- and Midcareer Pediatricians

Mind the Gap! Working Toward Gender Equity in Pediatric and Congenital Heart Disease: Present and Future

Evidence from medicine and other fields has shown that gender diversity results in better decision making and outcomes. The incoming workforce of congenital heart specialists (especially in pediatric cardiology) appears to be more gender balanced, but past studies have shown many inequities. Gender-associated differences in leadership positions, opportunities presented for academic advancement, and recognition for academic contributions to the field persist. In addition, compensation packages remain disparate if evaluated based on gender with equivalent experience and expertise. This review explores these inequities and has suggested individual and institutional changes that could be made to recruit and retain women, monitor the climate of the institution, and identify and eliminate bias in areas like salary and promotions.

Pediatricians' Career Satisfaction and Wellbeing by Sex Before and During the COVID-19 Pandemic

OBJECTIVE

To compare pediatrician career satisfaction and wellbeing by sex during the coronavirus disease 2019 pandemic with prepandemic years using longitudinal survey data.

METHODS

Data from a cohort study, the American Academy of Pediatrics Pediatrician Life and Career Experience Study, were used to examine career satisfaction and wellbeing from 2012 to 2021 among 2002-2004 and 2009-2011 residency graduates (n = 1760). Mixed effects logistic regression, including key pediatrician characteristics, examined career satisfaction and wellbeing measures for sex (female vs male), pandemic year (2012-2019 vs 2020-2021), and their interaction effect. Adjusted predicted percentage values (PVs) were determined.

RESULTS

In total, 73.4% of participants identified as female. Adjusting for key pediatrician characteristics, differences were found by sex for satisfaction and 4 of 5 wellbeing measures, by pandemic year for 2 wellbeing measures, and the interaction of sex and pandemic year for 3 wellbeing measures. Female pediatricians reported higher levels of anxiety, sadness, and work stress, with greater differences during the pandemic. For example, female pediatricians (PV = 22.6, confidence interval [CI] = 21.0-24.3) were more likely than male pediatricians (PV = 14.2, CI = 12.0-16.4) to report anxiety during pre-pandemic years, and the difference between female pediatricians (PV = 29.3, CI = 26.7-32.0) and male pediatricians (PV = 12.4, CI = 9.3-15.5) increased during pandemic years (sex by pandemic year interaction, P < .001).

CONCLUSIONS

Compared with male pediatricians, female pediatricians reported worse anxiety, sadness, and stress at work, and the differences were more pronounced during the pandemic.

Examining Full-Time Academic General Pediatric Faculty Compensation by Gender, Race, and Ethnicity: 2020-2021

OBJECTIVE

In medicine, women have lower lifetime earnings than men. To our knowledge, an in-depth examination of academic general pediatric faculty compensation by gender, race, and ethnicity has not been conducted. We aimed to 1) explore full-time academic general pediatric faculty salary differences by race and ethnicity; 2) explore these differences among all full-time pediatric faculty.

METHODS

We performed a cross-sectional study using data on median full-time academic general pediatric faculty compensation for the academic year of 2020-2021 from the Association of American Medical Colleges Medical School Faculty Salary Survey report. Pearson's chi-square tests were used to evaluate the association of faculty rank with gender, race, ethnicity, and degree. We used hierarchical generalize linear models with a log link and a gamma distribution to model to assess the association of median salary with faculty race and ethnicity, adjusting for degree, rank, and gender.

RESULTS

Men academic general pediatric faculty consistently had higher median salaries than women faculty even after adjusting for degree, rank, race, and ethnicity. Underrepresented in medicine academic general pediatric faculty had a lower median salary when compared to White faculty, and this was similar when adjusted for degree, rank, race, and ethnicity.

CONCLUSIONS

Our results demonstrated broad disparities in general academic pediatric compensation by both gender and race and ethnicity. Academic medical centers must identify, acknowledge, and address inequities in compensation models.

Work-Life Integration for Women in Pediatric Emergency Medicine: Themes Identified Through Group Level Assessment

OBJECTIVE

Women in medicine generally have higher burnout and lower career satisfaction and work-life integration compared with men. This study identifies factors that contribute to burnout, career satisfaction, and work-life integration in women pediatric emergency medicine (PEM) physicians.

METHODS

Self-identified women PEM physicians in the United States participated in a virtual focus group using Group Level Assessment methodology. Participants completed Group Level Assessment process steps of climate setting, generating, appreciating, reflecting, understanding, selecting, and action to (1) identify themes that contribute to burnout, career satisfaction, and work-life integration and (2) determine actionable factors based on these themes. Data were collected and thematically analyzed in real time through iterative processing. The group prioritized identified themes through rounds of distillation.

RESULTS

Seventeen women participated, representing 10 institutions (ages 30s-70s, 69% employed full-time). Participants identified 3 main themes contributing to burnout, career satisfaction, and work-life integration: (1) gender inequities, (2) supportive leadership, and (3) balance with family life. Actionable items identified were as follows: (1) development of initiatives to equalize pay, opportunity, and career advancement among genders; (2) implementation of an institutional focus on supportive and collaborative leadership; and (3) improvement of resources and supports for physicians with family responsibilities.

CONCLUSIONS

Women PEM physicians identified gender inequities, leadership, and balance with family life as major themes affecting their burnout, career satisfaction, and work-life integration. Several action steps were identified and can be used by individuals and institutions to improve work-life integration for women PEM physicians.

Industry Payments to Pediatricians in the United States Between 2013 and 2021

Financial relationships between physicians and the health care industry sometimes lead to conflicts of interest and need to be properly managed. Using the Open Payments Database between 2013 and 2021, this cross-sectional analysis examined the industry payments made to physicians whose primary specialty was pediatrics. Descriptive analyses were performed for the payment data overall and other pediatrician demographics. Of 99 764 eligible pediatricians, 59 984 (60.1%) received a total of $297 million (12.8%) in general and $2 billion in research payments over the 9 years. Median 9-year per-physician payments were $288 (interquartile range [IQR]: $88-$958) in general and $65 343 (IQR: $16 763-$255 208) in research payments. Male pediatricians were 1.06 (95% CI: 1.05-1.09, P < .001) and 1.56 (95% CI: 1.49-1.65, P < .001) times more likely to receive general and associated research payments than female pediatricians, respectively. The number of pediatricians receiving general payments annually decreased by 1.5% (95% CI: -1.7% to -1.4%, P < .001).

The physician gender pay gap in Maryland: current state and future directions

BACKGROUND

Over the last few decades, more attention has been paid to the physician gender pay gap and more interventions have been attempted. This paper discusses the physician gender pay gap between 2017 and 2021 in Maryland.

METHODS

An online cross-sectional survey was distributed to over 10,000 physicians in the Maryland Medical Society, featuring questions regarding employment characteristics, compensation, impact of the COVID-19 pandemic, and educational debt. Using descriptive and regression analyses, we explored cross-sectional associations between gender and employment characteristics.

RESULTS

Male physicians reported a significantly higher average 2020 pre-tax income ($333,732 per year) than female physicians ($225,473 per year, p < 0.001), amounting to a nearly 50% difference in raw income, consistent with a previously reported pay gap in 2016. Women physicians earned 31.5% less than their male colleagues in 2020 and were projected to earn 28.7% less in 2021. Female physicians were also more likely to have educational debt (33.6% vs.12.9%, p < 0.001) and also more likely to have a high burden of debt, with 36% owing over $200,000 in education loans, compared to 14.7% of men (p < 0.01).

CONCLUSION

The physician gender pay gap in Maryland has remained relatively stable over four years, including the period of the COVID-19 pandemic.

Factors Influencing Compensation of Early Career Neonatologists

OBJECTIVE

 Workforce characteristics and compensation specific to early career neonatologists remain poorly defined. Lack of transparency surrounding compensation limits benchmarking for neonatologists entering the workforce and may negatively influence individual lifetime earnings. Our objective was to provide granular data for this unique subpopulation by defining employment characteristics and factors influential to compensation of early career neonatologists.

STUDY DESIGN

 An anonymous 59-question cross-sectional electronic survey was distributed to eligible members of American Academy of Pediatrics Trainees and Early Career Neonatologists. A focused analysis was conducted on salary and bonus compensation data collected from the survey instrument. Respondents were classified based on primary site of employment: nonuniversity located (e.g., private practice, hospital employed, government/military, and hybrid employment groups) versus university located practice settings (e.g., work is primarily conducted in a neonatal intensive care unit (NICU) setting located within a university organization). Median quantile regression was used to conduct univariate and multivariate analyses using SAS Software version 9.4.

RESULTS

 We received 348 responses (26.7% response rate). Median salary was $220,000 (interquartile range: $200,000-250,000). Factors associated with salary include academic rank (instructor: $196,000; assistant professor: $220,000 [12% increase; p < 0.001]; associate professor: $260,000 [18% increase]; p = 0.027) and years of experience (p = 0.017), after adjusting for relevant factors. Employment location, practice type, group size, clinical schedule, location of medical school training, and gender identity did not significantly influence salary in multivariate quantile regression. Median annual bonus was $7,000 higher for nonuniversity located positions ($20,000 vs. 13,000; p = 0.021), with assumption of additional administrative roles and practice group seniority as most commonly cited bonus criteria (p = 0.002 and <0.001, respectively).

CONCLUSION

 Academic rank and years of experience may influence salary. Bonus earnings are higher for nonuniversity located positions. Employment models are evolving to incorporate academic teaching appointments while practicing in nonuniversity located NICUs. This is the first detailed compensation analysis of early career neonatologists.

KEY POINTS

· Transparent compensation data specific to early career neonatologists is lacking.. · Associated factors influential to compensation of early career neonatologists remain unclear.. · This study identifies years of experience and academic rank as possible factors influencing salary earnings of early career neonatologists.. · Practicing in nonuniversity located positions was associated with greater bonus earning potential..

The Current State of Workforce Diversity and Inclusion in Pediatric Critical Care

Literature suggests the pediatric critical care (PCC) workforce includes limited providers from groups underrepresented in medicine (URiM; African American/Black, Hispanic/Latinx, American Indian/Alaska Native, Native Hawaiian/Pacific Islander). Additionally, women and providers URiM hold fewer leadership positions regardless of health-care discipline or specialty. Data on sexual and gender minority representation and persons with different physical abilities within the PCC workforce are incomplete or unknown. More data are needed to understand the true landscape of the PCC workforce across disciplines. Efforts to increase representation, promote mentorship/sponsorship, and cultivate inclusivity must be prioritized to foster diversity and inclusion in PCC.

Representation of Women and Minority Faculty and Fellows in Academic Pediatric Cardiology Training Programs

BACKGROUND

Studies have shown that diverse care teams optimize patient outcomes. Describing the current representation of women and minorities has been a critical step in improving diversity across several fields.

OBJECTIVES

To address the lack of data specific to pediatric cardiology, the authors conducted a national survey.

METHODS

U.S. academic pediatric cardiology programs with fellowship training programs were surveyed. Division directors were invited (July 2021 to September 2021) to complete an e-survey of program composition. Underrepresented minorities in medicine (URMM) were characterized using standard definitions. Descriptive analyses at the hospital, faculty, and fellow level were performed.

RESULTS

Altogether, 52 of 61 programs (85%) completed the survey, representing 1,570 total faculty and 438 fellows, with a wide range in program size (7-109 faculty, 1-32 fellows). Although women comprise approximately 60% of faculty in pediatrics overall, they made up 55% of fellows and 45% of faculty in pediatric cardiology. Representation of women in leadership roles was notably less, including 39% of clinical subspecialty directors, 25% of endowed chairs, and 16% of division directors. URMM comprise approximately 35% of the U.S. population; however, they made up only 14% of pediatric cardiology fellows and 10% of faculty, with very few in leadership roles.

CONCLUSIONS

These national data suggest a "leaky pipeline" for women in pediatric cardiology and very limited presence of URRM overall. Our findings can inform efforts to elucidate underlying mechanisms for persistent disparity and reduce barriers to improving diversity in the field.

Examining Early Career Pediatrician Characteristics, Sacrifices, and Satisfaction

OBJECTIVE

Explore relationships between pediatrician characteristics, sacrifices made for career, and career and life satisfaction.

METHODS

Surveys of early career pediatricians (ECPs) who recently graduated residency (2016-18), as part of the AAP Pediatrician Life and Career Experience Study (PLACES) were administered in 2019. Logistic regression analyzed association of pediatrician characteristics with personal sacrifices (a lot vs some or no sacrifices) made for one's career and whether career was worth the sacrifices made to become a physician, and association of characteristics and sacrifices with overall career and life satisfaction.

RESULTS

Of 918 ECPs in the cohort, 90% responded to the 2019 survey. Seventy-seven percent agreed their career was worth the sacrifices and 40% reported they made a lot of personal sacrifices for their career. In multivariable analysis, female sex was associated with lower odds of viewing career as worth the sacrifices made [adjusted odds ratio [aOR] 0.45; 95% confidence interval [CI], 0.28-0.71], a higher odds of delaying starting a family [aOR 2.25; CI, 1.32-3.86] and making sacrifices in having children for career [aOR 2.60; CI, 1.48-4.58]. Those in fellowship training also reported making more sacrifices related to having children for their career [aOR 1.73; CI, 1.08-2.78]. ECPs who reported making a lot of sacrifices for their career were less likely to be satisfied with their overall career and life.

CONCLUSIONS

Most ECPs believe their sacrifices to become a pediatrician were worth it. Female pediatricians were less likely to feel personal sacrifices were worth it and reported more sacrifices related to having children.

Gender Discrimination and Sexual Harassment in a Department of Pediatrics

The last substantial description of gender discrimination and harassment described in the journal Pediatrics was in 2019. It is unclear whether the field has made progress toward its goal of equity. We aimed to describe: (1) the recent gender-equity climate according to women and men faculty in the department of pediatrics at a single, large academic center, and (2) institutional efforts to address persistent gender discrimination and harassment. In late 2020, we distributed an anonymous survey to all department faculty that included demographic data, a modified version of the Overt Gender Discrimination at Work Scale, questions about experiences/witnessed discriminatory treatment and sexual harassment, and if those experiences negatively affected career advancement. Of 524 pediatrics faculty, 290 (55%) responded. Compared with men, women more commonly reported gender discrimination (50% vs. 4%, P < .01) and that their gender negatively affected their career advancement (50% vs 9%, P < .01). More than 50% of women reported discriminatory treatment at least annually and 38% recognized specific sexist statements; only 4% and 17% of men reported the same (P < .01 for both). We concluded that a disproportionately low number of male faculty recognized the harassment female faculty experienced. In the 18 months since, our department and university have made efforts to improve salary equity and parity in leadership representation, created an anonymous bias-reporting portal, mandated bias training, and implemented new benchmarks of "professionalism" that focus on diversity. Although we acknowledge that culture change will take time, we hope our lessons learned help promote gender equity in pediatrics more broadly.

Physician Health and Wellness

Physician health and wellness is a complex topic relevant to all pediatricians. Survey studies have established that pediatricians experience burnout at comparable rates to colleagues across medical specialties. Prevalence of burnout increased for all pediatric disciplines from 2011 to 2014. During that time, general pediatricians experienced a more than 10% increase in burnout, from 35.3% to 46.3%. Pediatric medical subspecialists and pediatric surgical specialists experienced slightly higher baseline rates of burnout in 2011 and similarly increased to just under 50%. Women currently constitute a majority of pediatricians, and surveys report a 20% to 60% higher prevalence of burnout in women physicians compared with their male counterparts. The purpose of this report is to update the reader and explore approaches to pediatrician well-being and reduction of occupational burnout risk throughout the stages of training and practice. Topics covered include burnout prevalence and diagnosis; overview of national progress in physician wellness; update on physician wellness initiatives at the American Academy of Pediatrics; an update on pediatric-specific burnout and well-being; recognized drivers of burnout (organizational and individual); a review of the intersection of race, ethnicity, gender, and burnout; protective factors; and components of wellness (organizational and individual). The development of this clinical report has inevitably been shaped by the social, cultural, public health, and economic factors currently affecting our communities. The coronavirus disease 2019 (COVID-19) pandemic has layered new and significant stressors onto medical practice with physical, mental, and logistical challenges and effects that cannot be ignored.

Gender Discrimination and Reporting Experiences among Academic Pediatric Faculty: A Qualitative, Single-institution Study

OBJECTIVE

Gender-harassment is well-described in academic medicine, including pediatrics. We explored academic pediatricians' qualitative descriptions of: 1) workplace gender-harassment; 2) its professional and emotional tolls; 3) barriers to and outcomes of reporting gender-harassment; and 4) tools to intervene.

METHODS

We conducted a cross-sectional, anonymous, survey-based study within a single, large pediatrics department. Surveys included demographic items, validated measures to assess prevalence of gender-harassment, and optional, free-text boxes to elaborate. Here, we present the directed content analyses of free-text responses. Two trained qualitative researchers coded participant comments to identify types of gender-harassment, its impact, and participants' experiences reporting it. Final agreement between coders was outstanding (Kappa>0.9). A secondary, inductive analysis illustrated the emotional burdens of and opportunities to interrupt gender-harassment.

RESULTS

Of 524 total faculty, 290 (55%) completed the survey and 144 (27% of total, 50% of survey-respondents) provided text-responses. This sub-cohort was predominantly white women >5 years on-faculty. Compared to the full cohort, sub-cohort participants had more commonly witnessed/experienced workplace-harassment; 92% of sub-cohort women and 52% of men endorsed fear of reporting it. Respondents described harassment by institutional staff (24% of respondents), patients/families (35%), colleagues (50%), supervisors/leadership (50%), and the system (63%). Women used stronger emotional descriptors than men (ie, "humiliated" vs "uncomfortable"). Only 19% of women (and no men) had reported witnessed/experienced harassment; 24% of those described a negative consequence and 95% noted that no changes were made thereafter.

CONCLUSIONS

This single-center study suggests gender-harassment in academic pediatrics is common. Faculty feel fear and futility reporting it.

Association Between Workforce Gender Distribution and Lifetime Earning Potential in the Pediatric Subspecialties

OBJECTIVE

Examine the relationship between the gender distribution of the pediatric subspecialty workforce and lifetime earning potential.

METHODS

We estimated lifetime earning potential for pediatric academic subspecialists using mean debt and compensation data from national physician surveys for 2019 to 2020 and examined the relationship between the workforce gender composition and lifetime earning potential across the pediatric subspecialties using linear regression analysis.

RESULTS

Subspecialties with a higher proportion of women had lower lifetime earning potential (-$55,215 in lifetime earning potential/1% increase in the percentage of female subspecialists; P value .002, 95% CI -$24,429 to -$86,000). Similarly, a higher proportion of female first-year fellows was associated with lower lifetime earning potential (-$61,808 in lifetime earning potential/1% increase in the percentage of female first-year fellows; P value .026, 95% CI -$9,210 to -$114,405).

CONCLUSIONS

Consistent with patterns seen in other areas of adult medicine and surgery, pediatric subspecialties with higher proportions of women, such as adolescent medicine and endocrinology, tended to have lower lifetime earning potentials than subspecialties with higher proportions of men, such as cardiology and critical care. Lower earning subspecialties also tended to train higher proportions of women, suggesting that this trend may worsen over time as pediatrics in general and individual subspecialties in particular become increasingly female predominant.

Career Development in Pediatric Emergency Medicine: What Do We Need?

OBJECTIVES

The Women in Pediatric Emergency Medicine (PEM) subcommittee of the American Academy of Pediatrics Section on Emergency Medicine identified 2 top priorities for 2021: career development and mentorship/sponsorship. The objective of this study was to catalog and delineate the career development domains for women physicians in PEM.

METHODS

After a review of the literature to identify the key areas for gaps for women in PEM, we used Q sort methodology to elicit domains for this subcommittee to address by survey of a national sample.

RESULTS

One hundred fourteen discrete potential areas of interest for career development were identified by the working group based on salient themes from the literature and personal experiences. Forty-one Women in PEM subcommittee members (27%) completed the survey. The career development topics were sorted into the domains of personal (40.4%; n = 46), administrative (28.1%; n = 32), research (10.5%; n = 12), teaching (10.5%; n = 12), service (7.0%; n = 8), and clinical (3.5%; n = 4).

CONCLUSIONS

This study demonstrates that the career development needs of women in PEM include a range of personal, teaching, research, administrative, clinical, and service domains. However, more than two-thirds of the career development topics were categorized into just 2 domains, administrative and personal.

Words Matter: Examining Gender Differences in the Language Used to Evaluate Pediatrics Residents

BACKGROUND

Gender disparities in academic medicine continue to be pervasive. Written evaluations of residents may provide insight into perceptions of residents by faculty, which may influence letters of recommendation for positions beyond residency and reinforce perceived stereotype threat experienced by trainees.

OBJECTIVE

To examine language used in faculty evaluations of pediatrics residents to determine if there are differences in language used with respect to gender of resident.

DESIGN/METHODS

All faculty evaluations of residents in 3 consecutive intern classes from 2016 to 2018 were collected and redacted for name and gender identifiers. We performed a qualitative analysis of written comments in 2 mandatory free text sections. The study team initially coded text collectively, generating a code book, then individually to apply the coding scheme. Next, evaluations were unblinded to gender. Code applications were aggregated by resident, and frequencies of code application by resident were compared by standardized mean differences to detect imbalances between genders.

RESULTS

A total of 448 evaluations were analyzed: 88 evaluations of 17 male residents, and 360 evaluations of 70 female residents. Codes more frequently applied to women included "enthusiasm," and "caring," while codes more frequently applied to men included "intelligence," and "prepared." A conceptual model was created to reflect potential impacts of these differences using a lens of social role theory.

CONCLUSIONS

We identified differences in the way male and female residents are evaluated by faculty, which may have negative downstream effects on female residents, who may experience negative self-perception, differential development of clinical skills, and divergent career opportunities as a result.

Addressing Gender-Based Disparities in Earning Potential in Academic Medicine

IMPORTANCE

Gender-based disparities in compensation in academic medicine are recognized, but their estimated impacts on early career earning potential and strategies to mitigate them have not been well studied.

OBJECTIVES

To compare earning potential between female and male academic physicians in the first 10 years of posttraining employment and to evaluate the estimated impact of promotion timing, starting salary, and salary growth rate on earning potential.

DESIGN, SETTING, AND PARTICIPANTS

Using publicly available mean debt and compensation data for full-time employed academic physicians in the US from 2019 to 2020, starting salary, salary in year 10 of employment, annual salary growth rate, and overall earning potential in the first 10 years of employment were estimated for each gender by subspecialty. The estimated impacts of promotion timing and potential interventions, including equalizing starting salaries and annual salary growth rates, were modeled. Data analysis was performed from March to May 2021.

EXPOSURES

Gender and subspecialty.

MAIN OUTCOMES AND MEASURES

Starting salary, annual salary growth rate, year-10 salary, and earning potential in first 10 years of employment.

RESULTS

This cross-sectional study included compensation data from 24 593 female and 29 886 male academic physicians across 45 subspecialties. Women had lower starting salaries in 42 of 45 subspecialties (93%), year-10 salaries in 43 of 45 subspecialties (96%), mean annual salary growth rates in 22 of 45 subspecialties (49%), and earning potential in 43 of 45 subspecialties (96%) (median [IQR], $214 440 [$130 423-$384 954], or 10%, less). A 1-year delay in promotion from assistant to associate professor reduced women's earning potential by a median (IQR) of $26 042 ($19 672-$35 671), but failure to be promoted at all reduced it by a median (IQR) of $218 724 ($176 317-$284 466). Equalizing starting salaries could increase women's earning potential by a median (IQR) of $250 075 ($161 299-$381 799) in the subspecialties for which starting salaries for women were lower than those for men. Equalizing annual salary growth rates could increase women's earning potential by a median (IQR) of $53 661 ($24 258-$102 892) in the subspecialties for which mean annual salary growth rates were lower for women than for men.

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that gender-based disparities in starting salary and early career earning potential are pervasive in academic medicine in the US. Equalizing starting salaries would address the majority of the differences in earning potential.

Working Towards Gender and Racial Diversity in Pediatric Residency Programs in the United States

Introduction

The gender and racial profile of the pediatric population in the United States (US) is more diverse than that of the pediatricians that cater to their healthcare needs. Gender and racial diversity remains limited among pediatric residents and fellows, faculty, and leadership. Our study objectives were to explore the gender and racial disparity among pediatric residents in the US.

Methods

This was a retrospective analysis of the Accreditation Council for Graduate Medical Education (ACGME) database. The database encompassed all residents in US pediatrics residency programs from 2007 to 2021, categorizing them into White (non-Hispanic), Asian/Pacific Islander, Hispanic, African American/Black (non-Hispanic), Native American/Alaskan, others (races not included in the mentioned categories), and unknown. Gender was grouped into male, female, and not reported.

Results

From 2011 to 2021, the greatest increase in relative change (%) was seen for Asian or Pacific Islander (+58.42%), followed by Black (non-Hispanic) (+45.24%), White (non-Hispanic) (+43.37%), and Hispanic (+42.18%) races. The Native American/Alaskan relatively decreased 50%. The representation of female residents relatively increased by 13.27% as compared to the relative increase of male residents (+14.77%) from 2007 to 2021.

Conclusion

It is imperative to have a healthcare workforce that is representative of the existing communities in the US in terms of race, ethnicity, and gender to provide culturally sensitive care to the diverse patient population of the US.

Moving the Needle Toward Fair Compensation in Pediatric Nephrology

Remuneration issues are a substantial threat to the long-term stability of the pediatric nephrology workforce. It is uncertain whether the pediatric nephrology workforce will meet the growing needs of children with kidney disease without a substantial overhaul of the current reimbursement policies. In contrast to adult nephrology, the majority of pediatric nephrologists practice in an academic setting affiliated with a university and/or children's hospital. The pediatric nephrology service line is crucial to maintaining the financial health and wellness of a comprehensive children's hospital. However, in the current fee-for-service system, the clinical care for children with kidney disease is neither sufficiently valued, nor appropriately compensated. Current compensation models derived from the relative value unit (RVU) system contribute to the structural biases inherent in the current inequitable payment system. The perceived negative financial compensation is a significant driver of waning trainee interest in the field which is one of the least attractive specialties for students, with a significant proportion of training spots going unfilled each year and relatively stagnant growth rate as compared to the other pediatric subspecialties. This article reviews the current state of financial compensation issues plaguing the pediatric nephrology subspecialty. We further outline strategies for pediatric nephrologists, hospital administrators, and policy-makers to improve the landscape of financial reimbursement to pediatric subspecialists. A physician compensation model is proposed which aligns clinical activity with alternate metrics for current non-RVU producing activities that harmonizes hospital and personal mission statements.

Addressing gender inequities: Creation of a multi-institutional consortium of women physicians in academic emergency medicine

Gender inequity is pervasive in medicine, including emergency medicine (EM), and is well documented in workforce representation, leadership, financial compensation, and resource allocation. The reasons for gender inequities in medicine, including academic EM, are multifactorial and include disadvantageous institutional parental, family, and promotion policies; workplace environment and culture; implicit biases; and a paucity of women physician leader role models, mentors, and sponsors. To address some of the challenges of gender inequities and career advancement for women in academic EM, we established an innovative, peer-driven, multi-institutional consortium of women EM faculty employed at four distinct hospitals affiliated with one medical school. The consortium combined financial and faculty resources to execute gender-specific programs not feasible at an individual institution due to limited funding and faculty availability. The programs included leadership skill-building and negotiation seminars for consortium members. The consortium created a collaborative community designed specifically to enrich career development for women in academic EM, with a formal organizational structure to connect faculty from four hospitals under one academic institution. The objective of this report is to describe the creation of this cross-institutional consortium focused on career development, academic productivity, and networking and sharing best practices for work-life integration for academic EM women faculty. This consortium-building model could be used to enhance existing institutional career development structures for women and other physician communities in academic medicine with unique career advancement challenges.

Gender-based differences in physician payments within the fee-for-service system in Ontario: a retrospective, cross-sectional study

Background:

Differences in physician income by gender have been described in numerous jurisdictions, but few studies have looked at a Canadian cohort with adjustment for confounders. In this study, we aimed to understand differences in fee-for-service payments to men and women physicians in Ontario.

Methods:

We conducted a cross-sectional analysis of all Ontario physicians who submitted claims to the Ontario Health Insurance Plan (OHIP) in 2017. For each physician, we gathered demographic information from the College of Physicians and Surgeons of Ontario registry. We compared differences in physician claims between men and women in the entire cohort and within each specialty using multivariable linear regressions, controlling for length of practice, specialty and practice location.

Results:

We identified a cohort of 30 167 physicians who submitted claims to OHIP in 2017, including 17 992 men and 12 175 women. When controlling for confounding variables in a linear mixed-effects regression model, annual physician claims were $93 930 (95% confidence interval $88 434 to $99 431) higher for men than for women. Women claimed 74% as much as men when adjusting for covariates. This discrepancy was present in nearly all specialty categories. Men claimed more than women throughout their careers, with the greatest gap 10–15 years into practice.

Interpretation:

We found a gender gap in fee-for-service claims in Ontario, with women claiming less than men overall and in nearly every specialty. Further work is required to understand the root causes of the gender pay gap.

Innovative Wellness Models to Support Advancement and Retention Among Women Physicians

Despite improvements in representation of women in academic medicine, the rate of promotion and career advancement remains unequal. Compared with their male colleagues, women report lower rates of personal-organizational value alignment and higher rates of burnout. Particular challenges further exist for Black women, Indigenous women, women of color, and third gender or gender nonbinary faculty. Promoting the well-being of women physicians requires innovative approaches beyond the traditional scope of physician well-being efforts and careful attention to the unique barriers women face. Three wellness-oriented models are presented to promote the professional fulfillment and well-being of women physicians: (1) redefine productivity and create innovative work models, (2) promote equity through workplace redesign and burnout reduction, and (3) promote, measure, and improve diversity, equity, and inclusion. By engaging in innovative models for equitable advancement and retention, it is anticipated that diverse groups of women faculty will be better represented at higher levels of leadership and thus contribute to the creation of more equitable work climates, fostering well-being for women physicians.

The Physiatry Workforce in 2019 and Beyond, Part 1: Results From a Cross-sectional Survey

OBJECTIVE

The aim of the study was to describe the current physiatrist workforce in the United States.

DESIGN

An online, cross-sectional survey of board-certified physiatrists in 2019 (N = 616 completed, 30.1% response) collected information about demographic and practice characteristics, including age, sex, practice area, practice setting, hours worked, patient characteristics, staffing, and work responsibilities. Physiatrists were stratified by substantive practice patterns using a cluster analysis approach. Survey responses were arrayed across the practice patterns and differences noted.

RESULTS

The practice patterns identified included musculoskeletal/pain medicine, general/neurological rehabilitation, academic practice, pediatric rehabilitation, orthopedic/complex conditions rehabilitation, and disability/occupational rehabilitation. Many differences were observed across these practice patterns. Notably, primary practice setting and the extent and ways in which other healthcare staff are used in physiatry practices differed across practice patterns. Physiatrists working in musculoskeletal/pain medicine and disability/occupational rehabilitation were least likely to work with nurse practitioners and physician assistants. Physiatrists working in academic practice, general/neurological rehabilitation, and pediatric rehabilitation were most likely to have primary practice settings in hospitals.

CONCLUSIONS

Physiatry is an evolving medical specialty affected by many of the same trends as other medical specialties. The results of this survey can inform policy discussions and further research on the effects of these trends on physiatrists and physiatry practice in the future.

Women's Wellness Through Equity and Leadership (WEL): A Program Evaluation

BACKGROUND AND OBJECTIVES

The Women's Wellness through Equity and Leadership (WEL) program was developed as a collaboration between 6 major medical associations in the United States. The goal was to contribute to the creation of equitable work environments for women physicians. The purpose of the current study was to evaluate the pilot implementation of WEL.

METHODS

Participants included a diverse group of 18 early career to midcareer women physicians from across medical specialties, 3 from each partner organization. WEL was developed as an 18-month program with 3 series focused on wellness, equity, and leadership and included monthly virtual and in-person meetings. After institutional board review approval, a mixed-methods evaluation design was incorporated, which included postseries and postprogram surveys and in-depth telephone interviews.

RESULTS

Participants delineated several drivers of program success, including peer support and/or networks; interconnectedness between the topics of wellness, equity, and leadership; and diversity of participants and faculty. Areas for improvement included more opportunities to connect with peers and share progress and more structured mentorship. Regarding program impact, participants reported increased knowledge and behavior change because of their participation.

CONCLUSIONS

This longitudinal, cohort initiative resulted from a successful collaboration between 6 medical associations. Evaluation findings suggest that providing opportunities for women physicians to connect with and support each other while building knowledge and skills can be an effective way to advance wellness, equity, and leadership for women in medicine.

Equity for women in medicine-neonatologists identify issues

OBJECTIVE

Inequity between genders with regards to leadership achievement, compensation, scholarly productivity, and grant funding exist among physicians. This study explores whether similar inequities exist among board certified neonatologists within the USA.

STUDY DESIGN

A voluntary anonymous survey was distributed to 3575 members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine with 560 respondents (15.7% response rate). The survey contained questions assessing clinician characteristics, work environment, compensation, professional productivity, and social factors. Statistical analysis was done using JMP Pro 15.0.0 by SAS.

RESULTS

Female neonatologists, compared to male peers, were less likely to hold leadership positions (OR 0.36, p = 0.005), received lower compensation by an average of $34,916 or 12.47% (p < 0.001), and had 6.71 fewer primary authored publications (p = 0.025) after adjusting for several confounding factors.

CONCLUSION

Gender remains a significant independent factor influencing leadership attainment, compensation, and academic productivity in this cohort of neonatologists.

Practice composition and sex differences in physician income: observational study

OBJECTIVE

To assess whether differences in income between male and female physicians vary according to the sex composition of physician practices.

DESIGN

Retrospective observational study.

SETTING

US national survey of physician salaries, 2014-18.

PARTICIPANTS

18 802 physicians from 9848 group practices (categorized according to proportion of male physicians ≤50%, >50-75%, >75-90%, and >90%).

MAIN OUTCOME MEASURES

Sex differences in physician income in relation to the sex composition of physician practices after multivariable adjustment for physician specialty, years of experience, hours worked, measures of clinical workload, practice type, and geography.

RESULTS

Among 11 490 non-surgical specialists, the absolute adjusted sex difference in annual income (men versus women) was $36 604 (£29 663; €32 621) (95% confidence interval $24 903 to $48 306; 11.7% relative difference) for practices with 50% or less of male physicians compared with $91 669 ($56 587 to $126 571; 19.9% relative difference) for practices with at least 90% of male physicians (P=0.03 for difference). Similar findings were observed among surgical specialists (n=3483), with absolute adjusted sex difference in annual income of $46 503 ($42 198 to $135 205; 10.2% relative difference) for practices with 50% or less of male physicians compared with $149 460 ($86 040 to $212 880; 26.9% relative difference) for practices with at least 90% of male physicians (P=0.06 for difference). Among primary care physicians (n=3829), sex differences in income were not related to the proportion of male physicians in a practice.

CONCLUSIONS

Among both non-surgical and surgical specialists, sex differences in income were largest in practices with the highest proportion of male physicians, even after detailed adjustment for factors that might explain sex differences in income.

Women in Pediatrics: Progress, Barriers, and Opportunities for Equity, Diversity, and Inclusion

Gender bias and discrimination have profound and far-reaching effects on the health care workforce, delivery of patient care, and advancement of science and are antithetical to the principles of professionalism. In the quest for gender equity, medicine, with its abundance of highly educated and qualified women, should be leading the way. The sheer number of women who comprise the majority of pediatricians in the United States suggests this specialty has a unique opportunity to stand out as progressively equitable. Indeed, there has been much progress to celebrate for women in medicine and pediatrics. However, many challenges remain, and there are areas in which progress is too slow, stalled, or even regressing. The fair treatment of women pediatricians will require enhanced and simultaneous commitment from leaders in 4 key gatekeeper groups: academic medical centers, hospitals, health care organizations, and practices; medical societies; journals; and funding agencies. In this report, we describe the 6-step equity, diversity, and inclusion cycle, which provides a strategic methodology to (1) examine equity, diversity, and inclusion data; (2) share results with stakeholders; (3) investigate causality; (4) implement strategic interventions; (5) track outcomes and adjust strategies; and (6) disseminate results. Next steps include the enforcement of a climate of transparency and accountability, with leaders prioritizing and financially supporting workforce gender equity. This scientific and data-driven approach will accelerate progress and help pave a pathway to better health care and science.