There is much hubbub in the media currently about the gender pay gap. This phenomenon is unfortunately not new and is no less egregious today as it was at its inception. The gender pay gap is a problem that not only affects women in the United States but also across the globe.

So how did we get to a place where a large part of the labor force is not fairly compensated for their talent and skills? How did women in medicine and women in white coats end up being affected by this? After all, it does seem preposterous that in the professional environment, where advanced training and skill mastery is required, for there also to be inequity.

A Brief History of Labor Laws

In the United States, there have been a series of laws that have sometimes inadvertently led to pay inequity and worsened the gender pay gap over the almost 100 years. The Women’s Suffrage Act of 1920 afforded women the right to vote for candidates that would protect their labor rights, fair pay, and equality in the workplace.

The Fair Labor Standards Act (FLSA) passed near the end of the Great Depression (1938) in order to improve working conditions. It is not gender-specific but it does establish the 40 hour work week, an increased minimum wage, prohibited child labor, allowed for overtime compensation and safer working conditions.

There are reports that an estimated five million women entered the workforce between 1940-1945. There was a massive gap in the labor force associated with the deployment of men to the war. The aircraft industry was not previously open to females until this time. During the war, over 300,000 women worked in the aircraft industry – the quintessential Rosie the Riveter – making bombers and aircraft for the war effort.

In 1942, the National War Labor Board urged employers to make wage adjustments for women when they worked comparable jobs to men. Unfortunately, most employers ignored this and pushed women out of these types of jobs to make room for returning soldiers instead of complying with pay equity.

The Equal Pay Act of 1963 is the law that amended the Fair Labor Standards Act with the intent of eliminating wage disparity based on gender. President John F Kennedy contended that the gender pay gap and sex discrimination had deleterious effects on the nation as a whole by depressing wages and living standards for employees which directly connects to their health and efficiency while preventing maximum utilization of available labor resources.

The Civil Rights Act of 1964 outlawed discrimination based on race, color, religion, sex, or national origin. This law protects against hiring practices based on these categories.

Most recently, the Lilly Ledbetter Fair Pay Act of 2009, amended the Civil Rights Act of 1964 making the critical distinction that the 180-day statute of limitations for filing an equal pay lawsuit regarding pay discrimination resets with each new paycheck affected by that discriminatory action.

Gender Pay Gap in Medicine

Despite the presence of several laws in the United States of America, even several that mainly target salary equity, there is still a growing gender pay gap that is showing no real signs of correcting anytime soon. Unfortunately, medicine is not exempt from this phenomenon. There has been a rigorous analysis of these data, and the conclusions are the same. There is a gender pay gap.

The American College of Physicians released a position paper in May 2018 that reviews the paradox of increasing female physician numbers and no closure of the pay gap. There is an argument that this gap keeps widening due to confounders, like the choice of specialty, productivity, experience, and level of the faculty position. However, a JAMA study that takes these confounders as well as others into account. Unfortunately, the result is still the same. There have been several other studies that have come to the same conclusion.

So, all the reasons that JFK mentioned and many more for pay equity apply to medicine today.

To read more about the gender pay gap: Dr. Natasha K. Sriraman wrote a very a thoughtful piece on the effects of the presence of women in white coats, outcomes of care and the unfairness of the pay gap.

Dr. Charmaine Gregory is a night shift Emergency Physician practicing full-time at St Joseph Mercy Hospital Ann Arbor, MI. She is a co-author of The Chronicles of Women in White Coats. She is a survivor of physician burnout and has a penchant for fitness and physician wellness.