It’s 2019, and male cardiologists still make millions more than female cardiologists

A professional cardiology organization this week set out its first guidelines aiming to close the $1 million lifetime pay gap between female and male cardiologists. Other research has put that figure closer to $2.5 million over the course of a cardiologist's lifetime. 

There is a "persistent lack of diversity” in cardiology, according to the American College of Cardiology’s policy statement. Female cardiology fellows have told researchers at Stanford University that they worry about interventional cardiology’s long hours, the specialty’s use of radiation, and the traditionally male culture. To no surprise, only 13% of cardiologists are women, and only about 5% are practicing interventional cardiologists. 

That disparity also shows up in compensation. The ACC found that male cardiologists make between $31,749 and $37,717 more than their female counterparts. According to Medscape’s 2019 salary report, cardiologists make about $430,000 per year. There are a few reasons for some of that disparity. Interventional cardiologists usually make more money than cardiologists who don’t perform invasive procedures. And male cardiologists are more likely to take on higher-paid leadership roles. 

“It’s a very real thing,” said Dr. Sharonne Hayes, a cardiologist and director of diversity and inclusion at the Mayo Clinic. “Sometimes what you make is whom you know.”

Hayes was the physician sponsor for Mayo Clinic’s 2017 deep dive into total compensation packages for 2,845 physicians at the hospital system’s three campuses. (About 30% of those doctors are women.) One goal was to discern whether Mayo’s structured compensation model supported equity in pay, regardless of race or gender. The Mayo team found that about 80 doctors reported higher-than-average pay and 30 below-average-pay, but 98% of those findings had what Hayes calls explainable reasons, such as a disciplinary salary hold or working across two departments. Mayo's conclusion was that its pay model creates equity.  

“In terms of how to address inequity, creating transparent systems to measure productivity and report wages is a first step,” Dr. Rashmee Shah, assistant professor in cardiovascular medicine at the University of Utah School of Medicine, wrote in a 2018 JAMA Cardiology viewpoint that argues the lifetime pay gap is closer to $2.5 million. “Women lack negotiating power in a climate of ‘pay secrecy.’”  

A lack of diversity, whether or not that is driven by pay gaps, can also negatively affect health outcomes for patients. The fact that clinicians are just now starting to understand that the symptoms of cardiovascular disease in men differ from how they present in women is one example. A lack of female cardiologists may be to blame for that, said Dr. Aaron Paul Kithcart, a cardiologist at Brigham and Women's Hospital. Equal pay, he noted, is one way to ensure female cardiologists start and stay in cardiology careers. 

“The eye-opening experience was that last year there were several women who had been negotiating jobs at a fellowship that were getting significantly worse offers than I was,” he said. “This is what needs to be addressed.”

What’s your take? How would you fix the pay gap in medicine?

News I’m Watching

BUSINESS | Will air ambulance ‘insurance’ fill care gaps left by rural hospitals? Air ambulance companies are advertising subscription plans to residents who live in regions without a hospital that would provide free medical transport as needed, according to Kaiser Health News. One company has enrolled more than 3 million people in these plans. Rural hospital closures are a driving factor. A new study found that rural communities with hospital closures report that inpatient mortality rates go up. At the same time, the median price of air ambulances has jumped 60%, to $36,400 in 2017. 

Editor’s Pick: “Who controls which helicopter comes? How many people with a membership have been ‘wooed’ and then hung out to dry? Better yet, why isn't insurance covering flights?” - Jeremy Singleton, flight nurse

RESEARCH | C-section babies lack same gut bacteria mix as vaginally born babies. A new study in Nature examines the “baby biome” finding that vaginally born babies get their gut bacteria primarily from their mother, according to Reuters. C-section babies, on the other hand, have more bacteria from the hospital they were born in, including drug-resistant bacteria. There are rising rates of C-sections worldwide, a trend that has raised concerns about higher risks of obesity and autoimmune diseases. 

Editor’s Pick: “The study found that microbiome differences seem to even out by the time children are weaned. It will be interesting to see what the long-term differences are for these children.” - Nicole Reyna, Memorial Sloan Kettering Cancer Center

CAREERS | Health care worker strike threats move forward. About 8,900 registered nurses in four states plan to participate in a one-day strike on Friday. This includes RNs at the University of Chicago Medical Center, which moved pediatric patients to another hospital in preparation for the strike. Separately, an estimated 80,000 Kaiser Permanente workers said they will participate in a seven-day strike beginning October 14. Kaiser leadership said the union is taking an "aggressive approach" to contract negotiations. The rationale behind the strikes varies, from worker concerns about pay and health benefits to staffing ratios. 

Editor’s Pick: “The University of Chicago is taking precautions against nurse strikes by moving patients to other hospitals with no financial burden on patients. Why is the hospital not addressing the underlying reason for these strikes? What implications does it have on physicians and nurses in terms of malpractice?” - Dr. Adiba Khan

*Comments have been edited. 

What’s your take? How would you fix the pay gap in medicine? Share your thoughts in the comments, using #TheCheckup.