Marriage, children lead to fewer hours worked, less pay over time for female physicians

Getting married and having children lead to less pay over time for female physicians who work fewer hours relative to their male counterparts.

The pay gap adds up – from $1.6 million to $3.1 million over a 40-year career, said the study, “Marriage, Children, and Sex-Based Differences in Physician Hours and Income,” published in JAMA Health Forum. The information is crucial now because more than half of medical students are woman who will join the workforce as large numbers of male physicians retire over the next 10 years.

“As national leadership focuses on preparing the future physician workforce, we have reached a critical moment to address sex equity in physician reimbursement within health care institutions,” the study said. “Addressing the barriers that lead to women making less per hour and working fewer hours could achieve the dual aims of reducing male-female earnings disparities while expanding the effective physician workforce.”

Researchers examined data from 95,435 physicians from the American Community Survey of the U.S. Census Bureau from 2005 to 2019.

While it is well-established that male physicians earn more than female physicians, the exact reasons are not always clear. Previous studies have attributed factors such as female physicians working in lower-paying specialties, working fewer hours, or having fewer billable actions due to more time spent with patients.

But there has been no recent examination of how marriage and children affect pay, hours worked, and differences in earnings per hour, the study said.

Pay, time, and family

Whatever the family type, there was little variation in male physicians earning more per hour than female physicians: 21.4% more for singles, 23.9% for those married, and 21.5% for those with children. Those pay differences may be associated with female doctors practicing in lower-paying specialties, for any number of reasons, the study said.

For hours worked, the researchers found little difference between female and male physicians who are single.

But the gap in work hours “differed substantially” based on family type, and working fewer hours means a greater earnings penalty for female physicians, the study said. Married female physicians worked 7% fewer hours than married male physicians, while female physicians with children worked 17.5% fewer hours than male physicians with children.

“Thus, the greater male-female earnings gap among physicians who were married and those with children was largely due to a greater male-female gap in hours worked rather than differences in earnings per hour,” the study said.

Over a 40-year career, the differences in lifetime earnings tallied to about $1.6 million for single doctors, $2.5 million for physicians married without children, and $3.1 million for physicians with children. Actual earnings vary because most doctors spend at least part of their careers in more than one of the three family types, and have varying lengths of careers.

Authors Lucy Skinner, MPH, Max Yates, BSc, David I. Auerbach, PhD, Peter I. Buerhaus, PhD, RN, and Douglas O. Staiger, PhD, noted they did not control for structural sexism that could affect physician pay. Meanwhile, the larger trend of physician employment overtaking independent practice, could change pay inequities over time.

“Physicians are increasingly becoming employees of hospital systems, which gives these large-scale employers the opportunity to better support women in the workforce and to give female physicians greater freedom to choose historically male-dominated specialties and receive pay commensurate with hours worked,” the study said.

This article was published by our sister publication Medical Economics.