Money Matters: Unpacking Gender Bias in Compensation

Conversations about compensation are among the toughest for healthcare leaders to navigate. Add accusations of gender bias, and it’s a powder keg.

Beyond the surgical suites, labs and exam rooms, there’s a side of medicine that rarely becomes the subject of TV drama. You don’t find blood, guts or glory there, but it does get ugly. It’s where healthcare’s leaders—clinicians and administrators—live. The stuff that happens on the administrative side of medicine doesn’t make it onto our social media feeds or career highlights reels. They’re the stories that get shared under the cone of silence. We’re lifting the cone because the problems we encounter in our hospitals probably happen in yours, too.

CVB has given us a forum to host a conversation about healthcare management headaches and meltdowns that are, unfortunately, too common. Join us in discussing what happens before the damage controllers filter out the raw and real. 

True story 
“I am sick of getting f&^%ed because I’m female,” announces Dr. A as she storms into my office. “I’m going to find a new job.” 

Just the way you want to start a conversation.

“Can you give me some context?” I ask.  

“Drs. X, Y and Z all make more money than I do, even though their work RVUs are less and they bring in less revenue than I do!” she rants. “It’s because I’m a woman. They don’t do this $#!+ to the guys.”   

Over the past three years, Dr. A has been out on Family and Medical Leave Act–protected maternity leave twice, with both absences imminent during budget time. Both times, her division chief and chair, men in their late 60s and 40s, respectively, decided not to increase her salary while other physicians received raises. They voiced concerns about her productivity during absences and upon her return, and predicted she would “obviously be distracted by the baby.” They lamented the burden she was creating for her male peers and felt justified in their decisions. 

My colleagues around the country have shared, quietly, that such thinking is not uncommon, an unfortunate and unrealized byproduct of unintentional but unfair bias.

To their point: Dr. A’s wRVUs dropped by almost 1,000 for the year. 

To hers:  Dr. A outperformed all but one colleague in her division, exceeded her target goals by nearly 2,000 wRVUs and, yes, she was the lowest paid faculty member at her rank in the group. 

Real response 

› Taking a breath. I assured Dr. A that she was valued, pointing out that timing had contributed to the disparity. I also acknowledged that her complaints had merit and the chair needed to hear them. My task would be to help her present her case effectively. To that end, I didn’t share the assumptions (let alone the inflammatory tone) the chief and chair had expressed about her career trajectory. Instead, I reminded Dr. A that the chair responds to data. Her best bet for navigating a compensation increase would be presenting facts. Just facts. 

› Dealing in data: We broke out her annual compensation, including incentives, and her productivity data for the past five years. We compared both to the Association of American Medical Colleges national benchmarks. She was performing at the 75th percentile while being compensated at the 23rd. Even though she had capped her incentives every year, her annual compensation percentile was actually dropping. Dr. A’s wRVUs had dropped over the same period, but only from the 85th to the 75th percentile—still significantly higher than her benchmarked compensation percentile. On average, her colleagues’ productivity also had dropped.  

› Making the case: Dr. A’s position was solid. I coached her to focus on making the case for her own value. Basing her argument on the unfairness of past decisions or accusations about gender bias would raise the chair’s defenses. Dr. A and I agreed that she wouldn’t threaten to leave, that getting a raise as a result of an ultimatum wouldn’t serve her in the long run.

By the time we met with the chair, Dr. A had a compelling story to tell. She had gained confidence from building the case and practicing her presentation. The meeting went very well, in part because she stayed on point and kept her tone matter of fact. The chair agreed that she was underpaid and increased her salary substantially, beyond that of her peers, in fact. He even facilitated an off-cycle compensation adjustment. 

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Debrief 

Unfortunately, conversations like this one aren’t uncommon in healthcare management. Compensation is a hot-button topic that causes distress and leads to volatile exchanges. In this scenario, both sides effectively “won,” but that’s not always what happens. Many times, in scenarios like this, the physician doesn’t “win” and eventually moves on to another job. We can learn a lot from the wins vs. the losses.

Dr. A’s story ended well in large part because she was open to being coached, she calmed down and studied the data, and because our approach gave me time to prepare the chief and chair. They needed to hear, from someone other than Dr. A, that a problem was brewing and that her complaint was legitimate. The difference between this scenario and many of the losses we’ve witnessed was Dr. A made an effort to understand her audience and framed the discussion toward achieving a productive outcome for everyone.  

She came around to believing that success was not about being right but rather understanding the emotions in play and setting a goal of shared understanding and wins for everyone. 

Editor’s Note: Real Talk is a recurring feature in Cardiovascular Business, with stories reflecting some of the uncomfortable, look-the-other-way realities of cardiovascular medicine and practice. It is told from an anonymous perspective to encourage honesty and objectivity, without sugarcoating. This issue’s authors are practice administrators from the Southeast. If you have a story, experience or lesson to share, email me at kbdavid@cardiovascularbusiness.com.