Note to Sachin Joshi: why medicine's gender pay gap ACTUALLY exists

Note to the Liberal Party’s Sachin Joshi: Here’s why medicine’s gender pay gap ACTUALLY exists

Another day, another male ‘expert’ telling female doctors why the gender pay gap exists in medicine. Usually it’s because we work fewer hours, undervalue ourselves by charging patients reasonably and ethically, choose to spend more time with patients and earn less for those longer consultations, choose specialties with lower earning potential, and choose not to own our own practices.

Today, according to Liberal candidate Sachin Joshi, it’s because female doctors are “less active/interested in pursuing business skills… lesser priority on understanding money matters, dealing with staff issues, managing commercial aspects and other business related ‘stuff’.”

The first point I want to make is that this is a conflation of issues. Firstly, there is the issue of a gender pay gap in medicine, defined as the difference in pay for women doing the same work as men. Secondly, there are genuine issues around business participation and ownership among women. To link and relate these two separate issues is a fallacy. The latter may explain why female doctors own fewer businesses or are less wealthy than men (at a statistical population level), but the former is a genuine disparity in per hour pay, which is seen across all levels of medicine.

Dr. Kirsten Connan is an Obstetrician and Gynaecologist with an award winning practice in Hobart. She believes that the gender pay gap is complex, and entrenched in cultural, social and gender expectations, not a lack of desire or expertise on the part of women.

With regards to the gender pay gap, in Australia, we haven’t really measured it. Some of this has been measured in general practice, and I detailed the reasons for this pay gap last year. In summary though, female GPs manage more individual problems per consultation, and are more likely to address social problems that also impact on health, such as domestic violence and unemployment.

Despite this, female GPs charge Medicare fewer items, thus saving patients and taxpayers money. They are more likely to undertake unpaid tasks that benefit patient health in their own time. They are more likely to bulk bill patients, meaning that they accept the much lower Medicare rebate, rather than the fees which reflect their business costs. At a population level, female GPs earn around 25% less per hour than male GPs.

While it can be seen as a ‘choice’, regardless of gender, to practise medicine in a less lucrative way, it seems to me that the genuine accusation should be that some people, regardless of gender, choose to practise medicine in a lower quality way. Many male GPs practice excellent medicine, but at a population level, statistically, women, as a group, are more likely to spend more time with their patients and earn less.

Public hospitals claim to be free of a gender pay gap as all employees are on the same award wage, and yet this is an unsubstantiated claim as no one has actually measured this. Anecdotally, women are less likely to be offered overtime, less likely to claim the overtime they have worked, and less likely to have the overtime they worked approved and paid.

Even when it comes to hiring senior positions, women are often explicitly given fewer hours than men, because the expectation that women will want maternity leave which will ‘affect the roster’ is still pervasive. Perversely, award rates are lower for those who work fewer hours per week, and so the gender penalty is applied twice – both in not getting the hours desired, and then in being paid less to undertake the same work.

So while the potential under-representation of women in business ownership may lead to the significant difference in taxable income between men and women reported by the ATO, at least some part of this is a genuine pay gap in per hour pay due to complex reasons.

When it comes to owning practices, Dr. Jill Tomlinson has a few things to say. She is a Plastic, Reconstructive and Hand surgeon with a very busy and successful practice in Melbourne, and believes that women are treated differently than men, both in business and in society. Dr Connan agrees, saying that her experience of the culture in medicine is one where there is overt discouragement of women having financial conversations. When female colleagues discuss business and revenue, they are perceived to be less compassionate, and Dr Connan feels that this implies that clinical excellence and business excellence cannot coexist.

Tomlinson acknowledges that establishing and running a successful business requires overcoming barriers. In addition to running businesses, women in medicine face the usual challenges of spreading limited resources thin in order to succeed at many things at once. These resources might be financial, or time and attention. Tomlinson notes that societal expectations and family commitments do play a role, with women facing higher expectations and greater challenges when it comes to carer responsibilities.

In addition, it is clear that while there is a gender pay gap, there is also a genuine motherhood penalty, where men who become fathers are given greater opportunities because they are seen as now having family to support, whereas women face a penalty as they are seen to now be less committed.

Dr. April Armstrong is the Director and Founder of Business for Doctors, a membership organisation with 25,000 Australian doctors. Despite, these barriers and challenges, 53% of the member base of Business for Doctors is female. Armstrong opposes the view that female doctors are less inclined to have a business mind; in her experience she has seen many female practice owners who have exceeded expectations and excelled in their area of business.

It is her opinion that in fact women are better business owners than men specifically in the medical sector – she feels women have more compassion and balance to social welfare and justice, and provide a more positive supportive environment for staff. Armstrong finds it amazingly distasteful that a political candidate would suggest that female medical practitioners are inferior in business.

Like in many other areas, one of the key things that women require to start and run their own business is support, and many women point to this. Dr. Amy Touzell is an orthopaedic surgeon currently building her business, and recently visited a number of established practices run by female colleagues. She says that the support of these women, who were generous with their time and advice, has provided her with many ways in which to improve her own efficiency and service.

Dr Tomlinson likewise cites her mentors who provided encouragement and opportunities, as well as a support network that she can call all when she needs assistance with the many aspects of running a small business. These networks are especially important as Dr Tomlinson notes that imposter syndrome and a fear of failure can dissuade talented women from seeking out, creating, and embracing opportunities.

Dr Connan has found support in the Telstra Business Awards and Commonwealth Bank Women in Focus networks. The large membership of Business for Doctors attest to the fact that female doctors are active in discussing business, seeking opportunities, and learning from each other.

So while yet another person might make an assertion as to womens’ capacity to do business as a cause of lesser pay, my experience is of a world where women not only excel at business, but where women are generously supporting other women to achieve both financial and clinical excellence.

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