It’s been over 50 years since gender-based wage discrimination became illegal in 1963, but the salary gap continues. In 2020, women were paid 83 cents for every dollar given to men. This disparity is particularly prominent in medicine, where “indefensible differences in salary between men and women persist,” according to a Harvard Business Review article.

One in five U.S. surgeons are women, but there are currently no surgical specialties in which women and men are paid the same. But even as women continue to make strides towards receiving equal pay, the struggle is far from over.

Here are five things you may not know about the gender pay gap among surgeons:

Female surgeons earn nearly $20,000 less annually than male surgeons.

After taking specialty, age, faculty rank and metrics of clinical and research productivity into consideration, female surgeons earn nearly $20,000 less annually than their male peers, according to a recent report from the Association of Women Surgeons.

This wage gap begins on entry into the workforce and widens over time: Women surgeons will earn 90% of what men are paid until age 35, and then that number drops to around 82%.

Male surgeons are able to pay off their school debt well before their female counterparts.

While men and women typically graduate with the same amount of debt, women will only be able to pay off 33% of this debt after five years, while men will be able to pay off 44%. The average medical school debt is $200,000, according to a 2020 Association of American Medical Colleges report, but nearly a fifth of medical school graduates have debts totaling $300,000 or more.

Orthopedic surgery has one of the highest gender wage gaps of all specialties.

According to Doximity’s 2020 physician compensation report, male orthopedic surgeons make an average of $614,447 a year while female orthopedic surgeons make just $491,770 a year. Other specialties with high wage gaps include otolaryngology, geriatrics and research.

Specialties with the smallest wage gaps were nuclear medicine, hematology and urology. Overall, researchers found that the gender wage gap for medical professionals is 28%, up nearly three percentage points from the previous year.

Female general surgery residents expect to be paid less than their male counterparts.

In their study of 407 residents across 19 U.S. general surgery programs, Grey et al. found that female general surgery residents expected their minimum acceptable starting salary to be $18,198 less than men predicted theirs would be ($249,502 vs $267,700). They also reported their ideal starting salary to be $29,954 less than their male counterparts ($334,709 vs. $364,663).

Male plastic surgeons receive on average more than twice the consulting payment dollars that their female counterparts receive.

In their 2020 Aesthetic Surgery Journal report, Moore et al. examined industry-based transfers given to members of the American Society of Plastic Surgeons (ASPS) between 2013 and 2018, which they consider to be “hidden pay…[that] exposes compensation disparity not captured by traditional wage-gap estimations.”

They found that of the 3,864 ASPS plastic surgeons who reported industry payment, men accepted more and higher-value transfers from industry patients than women did. The average number of funds transferred to men was $25,468, while women received $11,530.

What’s Driving This Gap in Surgeon Pay?

Researchers have found that the pay gap may begin with how starting salaries are negotiated, creating a gap that continues to widen over time. Another factor may be maternity leave: A study found that upon returning to work after maternity leave, female proceduralists reported having to complete missed call shifts, owing money to their practice and losing productivity bonuses. There may also be a referral bias that affects how quickly female surgeons can build up their practice—one study found that male physicians refer more patients to male surgeons.

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