The implications of gender segregation in medical specialties

Elaine Pelley, MD, associate professor (CHS), Endocrinology, Diabetes and Metabolism

Despite large increases in the number of female physicians over the past four decades, there has been no progress in gender integration of the medical specialties over this time. While there are more women in medicine overall, medical trainees continue to distribute into specialties in ways that reinforce pre-existing gender imbalances. 

Thus, while female physicians remain relatively scarce in certain specialties, they are becoming overrepresented in others—a phenomenon that appears be associated with a relative decline in earnings for physicians in those specialties over time.

These were among the issues presented in a recent Academic Medicine Perspective article by Elaine Pelley, MD, associate professor (CHS), Endocrinology, Diabetes and Metabolism (pictured in banner above), and Molly Carnes, MD, MS, professor, Geriatrics and Gerontology, and Virginia Valian Professor (pictured at right). Molly Carnes, MD, MS

Specifically, the authors found a strong negative relationship between the proportion of female physicians in a specialty and its mean salary, with gender composition explaining 64 percent of the variation in salaries among the medical specialties.

Potential reasons for ongoing gendered selection of specialties include gender-based assumptions regarding skills and “fit,” the availability of mentoring and role models, the content of medical student performance evaluations, and verbal messages about career choice.

Female physicians have decreased promotion rates, are underrepresented in leadership roles, face a substantial gender pay gap and have higher rates of burnout.  The clustering of women in certain specialties means these specialties will be disproportionately affected by gender bias, which in turn has an impact on interest from potential applicants into the field.

To mitigate this, the authors proposed increasing the visibility of mentors and role models of both genders in all specialties, and including male trainees and faculty in medical student interest groups for female-predominant specialties.  Long term, eliminating the societal conflation of gender and status would decrease gender segregation and its impact on salaries and thus the negative role the lower salaries play in recruitment.

“Recognizing the consequences of gender demographics within physician specialties is important to maintain the strong and diverse physician workforce needed to support the health care needs of the populations who depend on these specialties for care,” they wrote.

Banner: Elaine Pelley, MD, associate professor, Endocrinology, Diabetes and Metabolism, is the lead author on a Perspective article in Academic Medicine that examines gender segregation in medical specialties. Credit: Clint Thayer/Department of Medicine.