Addressing Gender Equity and Diversity in Canada’s Medical Profession
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Whenever you encounter a person, for example, your brain rapidly engages in a series of calculations to interpret that person's relevance to you by placing them within a social category.T he first automatic calculations regard age, race, and gender. Because of this perceptual primacy, gender has come to frame the way we see the world; it is an implicit or unconscious bias that serves as a foundation upon which stereotypes, expectations, and norms have been created. Social categorisation is an inevitable part of our perceptual experience, such that the stereotypes we hold about different social groups will alter our perceptions of, and reactions to, individual group members. Further, when it comes to devaluing women's contributions in masculinised settings, women can be just as biased as men, meaning that people of all gender identities can perpetuate gender bias in organisations. Rejecting the idea that only some people are biased is a crucial first step to personally engaging with the problem of discrimination so as to bring about change.
In this article, we summarize evidence on the gender pay gap in medicine in Canada and abroad, and discuss common myths, likely root causes and possible solutions. We start with the premise that equal pay for equal work is a matter of fairness and is necessary for the profession to move from aspirations of gender inclusion to equity and justice for women. Gender is not binary; however, we focus on differences in pay between groups defined in the data as men and women (Vogel L., 2017). Currently, there is little research on the experiences of nonbinary physicians. In the broader Canadian workforce, the pay gap is larger for women who are Indigenous, racialized or newcomers, or are living with a disability. However, there are few comparable data in medicine, and discussing how the intersection of different identities may affect pay disparity is beyond the scope of this article. Numerous studies, mostly from the United States and the United Kingdom, have shown a clear gender pay gap among physicians. This effect is seen in clinical, research and environments. Inequities start at the early stages of a medical career, deepen with time, continue into retirement and affect lifetime wealth, with estimates as high as $2.5 million over a 30-year career. The pay gap in medicine persists after adjustment for factors like physician age, specialty, number of hours worked and practice characteristics. The limited data available in Canada suggest a similar situation. The proportion of women among Canadian physicians has grown rapidly, from 11% in 1978 to 43% in 2018. Yet data from Ontario show that women account for only 8% of the province’s highest-billing physicians (Biringer A, Carroll JC, 2012). Our own analysis of Canadian data, along with analysis done by others, suggest that some pay differences are driven by specialty but that there are also gender pay differences within specialties.
Csanady A. Ontario’s doctor wage gap: just eight per cent of province’s top-billing MDs are women. National Post [Toronto] 2016 Apr. 29. Available: https://nationalpost.com/news/politics/ontarios-doctor-wage-gap-just-eight-per-cent-of-provinces-top-paid-mds-are-women
Bogler T, Lazare K, Rambihar V. Female family physicians and the first 5 years: in pursuit of gender equity, work–life integration, and wellness. Can Fam Physician 2019;65:585–8.
Biringer A, Carroll JC. What does the feminization of family medicine mean? CMAJ 2012;184:1752.
Vogel L. Pay gap growing between family doctors, other specialists. CMAJ 2017; 189:E1300.