Healthcare, with women holding 77% of its jobs, could be a strong leader in gender equity for pay. Instead, its pay gaps are growing in complexity — and at a really bad time.
Researchers from the University of Minnesota and University of Washington examined healthcare's pay gaps across occupational and educational groups to better understand how pay discrepancies have changed among cohorts of workers from 2003 to 2021. Researchers analyzed the average annual wage and salary income for women and men in specific education and occupation categories. They included numerous control variables in their analysis, including of age, underrepresented minority and immigrant status, marital status, part-time status and distinction of rural or non-urban areas.
Here are seven key findings from their research, published in Health Affairs:
1. The gender wage gap is most pronounced in healthcare's high-education jobs, such as physicians or advanced practitioners, even though the gaps have narrowed in the last 20 years. At the same time, gender pay gaps have remained stagnant or widened for jobs requiring lower educational qualifications. Combined, jobs in healthcare with the highest and lowest educational qualifications see the greatest gender pay gaps.
2. For comparison, women's annual earnings in the general workforce were 82.3% of men's in 2020. The gap is wider for women of color: Hispanic women earned just 57 cents and Black women earned 64 cents for every $1 earned by White, non-Hispanic men in 2020.
3. The gender wage gap is widest for physicians (70%) and advanced practitioners (68%) and narrowest for community-based workers (96%) and RNs (82%), with therapists, LPNs, aides/assistants, and technicians clustered together at approximately 80% in 2021.
4. The gender wage gap improved between 2003 and 2021 for therapists (43% change), physicians (41% change), advanced practitioners (36% change), community-based workers (30% change) and technicians (9% change). The gender wage gap widened among aides/assistants (−11% change) and RNs (−5% change) over the same timeframe.
5. The gender wage gap narrowed between 2003 and 2021 among workers with a bachelor's (14% change), master's (11% change), and professional/doctoral degree (15% change), but widened among those with lower levels of education, including those with a high school degree (−6% change).
6. Wage gaps persist even though the gender representation in healthcare is changing. For instance, representation of women between 2003 and 2021 increased by 26% among physicians. Men's representation increased in nursing, on the other hand. In 2003, approximately 93% of RNs were women, but this dropped to approximately 88% in 2021.
7. One explanation of the gender wage gap offered by researchers is the "glass escalator," in which men in women-dominated careers earn higher wages and are more likely to be promoted than their women peers. "These patterns likely reflect some preference by employers for masculine traits and a willingness to reward men at a higher rate than women," researchers note.
The study and its findings raise serious questions for the industry and health systems.
First, how long will wide pay gaps persist for physicians at a time when the U.S. simply needs more of them, as soon as possible? The U.S. faces an estimated shortage of 37,800 to 124,000 primary care and specialist physicians by 2034. Although the gender pay gap has narrowed for physicians, it still stands at females earning 70 percent of their male counterparts. Less pay for the same demanding work is a detractor at a time when the U.S. simply needs more physicians, raising questions about how long this gender pay gap will persist.
Second, when will healthcare organizations get their own house in order? Health systems are devoting more energy and focus to health equity, yet gender pay gaps persist or are even widening, as the study shows, among their own workers. Less pay for the same work is a social determinant of health that organizations stand to create or eliminate.
Third, why is the gender pay gap widening among workers who may be more vulnerable in the labor market? The widening gender pay gap among healthcare jobholders with lower educational qualifications does not bode well for equity, and is at cross purposes with health systems' goals to strengthen ties to secondary education with hopes that involvement early on will influence high school students to pursue careers in medicine and healthcare.