Women cardiologists don't receive equal pay for equal work, study finds

Women cardiologists not only practice in different ways than their male colleagues, but are paid less—nearly $32,000 on average—even after accounting for differences in job description, practice setting, and productivity, according to a study presented November 8, 2015 at the annual American Heart Association meeting and simultaneously published in the Journal of the American College of Cardiology.

“This is the first study to show that although men and women cardiologists share the same specialty, they have markedly different job descriptions,” explained the study’s senior author Pamela Douglas, MD, Geller Professor of Research in Cardiovascular Diseases at the Duke Clinical Research Institute, Durham, NC. “Thirty-nine percent of men are interventionalists vs 11% of women, and this sets the stage for higher compensation.”

Interventional procedures generally have higher relative value unit (RVU) scores than cognitive services, the researchers noted, so interventional cardiologists typically generate more RVUs than other cardiology subspecialists. Accordingly, men cardiologists generated a median 9,301 RVUs while women generated 7,430.

“Of note, the observation that women generated fewer wRVUs in this study must be taken in the context of the observations regarding differences in specialization, and not simply a difference in productivity,” the authors wrote. “That differences in pay exist even after accounting for differences in specialization and wRVU-based productivity is particularly striking.”

For this study, researchers obtained MedAxiom survey data for calendar year 2013 on personal, job, and practice characteristics of 2,679 cardiologists (229 women, 2,450 men) from 161 community practices. They constructed a salary regression model that included a number of independent variables.

They found that median salary was more than $100,000 higher for men cardiologists ($502,251) than for women cardiologists ($394,586).

A secondary analysis projected that the women in this sample would have been expected to earn a mean salary of $432,631, based on their productivity and other characteristics, had they been male. But the actual observed mean salary for women was $400,882—a shortfall of $31,749 that wasn’t explained by the factors evaluated in this study.

The researchers also found that women cardiologists:

• Were more likely to specialize in general/non-invasive cardiology (53.1% vs 28.2%)
• Were generally younger—56% of women cardiologists were under age 49 compared with 38.8% of men
• Worked on a full-time basis (about 80%) in fewer numbers than men (nearly 91%).
• Were slightly less likely to be on call. Although most cardiologists had full on-call responsibilities (82.5% overall), more women than men took no call (17.5% vs 7.2%) or partial call (15.0% vs 8.9%) rather than full on-call duties (67.5% vs 83.9%).

“The differences in sub-specialization and practice were striking and merit note,” said the study’s first author Reshma Jagsi, MD, Associate Professor at the University of Michigan, in Ann Arbor, MI. “But it’s also important to note that the difference in compensation between men and women couldn’t fully be explained by differences in subspecialty, procedures, or the many other personal, job, and practice characteristics that we evaluated.”  

The study didn’t explain why women opt for general cardiology rather than subspecializing in interventional cardiology, nor did it explain the differences in the workload. Further study is needed to determine whether women are discouraged from pursuing interventional careers due to gender bias/discrimination or unfounded concerns about occupational radiation exposure, the authors wrote.

“It’s important to be looking at this, because we as a profession are not having full access to our talent pool of qualified internal medicine residents,” Dr. Douglas said. “That becomes a business and health care issue, as we increasingly recognize the importance of diversity among providers to optimizing patient care.”