Women comprise 43% of the US workforce and 35% to 36% of all physicians, but they comprise 63% of pediatricians in the United States.1,2  Pediatricians are at the forefront of an increasingly and disproportionately female primary care workforce,1  and understanding ongoing gender wage gaps in this profession offers insight into both the valuation of primary care medicine and women’s labor. To that end, Frintner et al’s3  article, “Gender Differences in Earnings of Early- and Midcareer Pediatricians,” provides disheartening news. Even in this female-dominated profession, in which women may have greater opportunity to organize and demand equal pay for equal work, women receive 76 cents on the dollar relative to their male counterparts.3  Note the following: We use the term “gender” (based on social construction) rather than sex (based on biology) in our discussion of salary differences by self-reported sex because the reasons for the difference are social rather than biological.

Frintner et al’s3  analysis of this large national cohort of graduates of pediatric residency programs in the United States further demonstrates that the observed gender wage gap is partially explained by demographics (eg, race and/or ethnicity), labor-force participation characteristics (eg, specialty and work hours), job characteristics (eg, workload and work setting), and work–family characteristics (eg, children, periods of work reduction, and work choices made for the family). Although these findings are not surprising and reinforce the reality of gender differences in household labor responsibility versus salary generation expectations based on sex, they also demonstrate that a 6% wage gap persists even after accounting for all these factors. This remaining gap may be attributable to ongoing gender discrimination in the workplace. Almost half of all working women in the United States report that they have experienced gender discrimination in the workplace,4  and certainly such discrimination extends to salary. Unfortunately, this analysis could not provide insight into the intersectionality of discrimination (ie, salaries for underrepresented minority women), outside of showing a significant difference in salary by race and/or ethnicity, because numbers for underrepresented racial and/or ethnic subgroups were too small to allow for analysis, a statement in itself. Nonetheless, we know these disparities persist by race and/or ethnicity as well as by sex and are part of the picture of unequal salaries.

As noted in Frintner et al’s3  article, previous researchers have documented this persistent gender wage gap among physicians and the US labor force as whole, but findings from their study shed light on this issue in ways that also indicate some promise on this issue. This pediatrician wage gap is less than that seen for physicians as a whole and is even less for the US labor force as a whole.2  Hence, pediatrics appears to be managing the gender wage gap better than most and in a context in which recent increases in physician salaries across US medical schools have been greater for pediatricians than for other specialties.5  In part, this may be due to greater salary stagnation in pediatrics departments before this point, and salaries in pediatrics are notably lower than those seen in other specialties, possibly corresponding to higher proportions of women in pediatrics. Nonetheless, there is cause for cautious optimism. There is evidence of a decline in the gender wage gap broadly, and particularly among younger professionals aged 25 to 34 years.4  Greater transparency in salaries and available publication of national salaries by national bodies such as the Association of American Medical Colleges has likely helped in this vein, although the Association of American Medical Colleges could improve on this by making the salary information freely available because it currently is only available at cost.5  Women’s greater recognition and expectation of equal pay for equal work is also a timely issue, and we could use this work for advocacy in pediatrics, other medical specialties, and women’s employment as a whole. Simultaneously, as we move forward in our demands for equal pay for equal work, we must also advocate for and alter social norms around male participation in domestic spheres, and particularly child care responsibilities. Women’s loss in salary to be with children occurs in parallel with men’s loss of time to be with children, and we need equality in both spheres for stronger families and a more robust health care workforce. We also need to recognize, value, and pay women for their work at a level equal to their male counterparts, and pediatrics as a professional and female-dominated field can and should be at the forefront of prioritizing the call for equal pay for equal work.

Opinions expressed in these commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees.

FUNDING: No external funding.

COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2018-3955.

1
AAMC
.
Active physicians by sex and specialty, 2017: Table 1.3. Number and percentage of active physicians by sex and specialty, 2017. Available at: https://www.aamc.org/data/workforce/reports/492560/1-3-chart.html
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US Department of Labor, Women’s Bureau
.
Employment and earnings by occupation. Available at: https://www.dol.gov/wb/occupations_interactive.htm
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Faculty salaries increased 2.7% in 2018. Available at: https://news.aamc.org/patient-care/article/faculty-salaries-increased-27-2018/

Competing Interests

POTENTIAL CONFLICT OF INTEREST: The author has indicated she has no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The author has indicated she has no financial relationships relevant to this article to disclose.