SGEM Xtra: Money, Money, Money It’s A Rich Man’s World – In the House of Medicine

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Date: September 28th, 2020

Guest Skeptic: Dr.Michelle Cohen (@DocMCohen). She is a rural Family Physician, writer (CBC News, Toronto Star and McLean’s Magazine), Assistant Professor Queens University and the Co-Chair of the Advocacy Committee of Canadian Women in Medicine.

Dr. Michell Cohen

This is an SGEM Xtra episode based on an article by Dr. Cohen and Dr. Kiran published in the Canadian Medical Association Journal (CMAJ). The article was called Closing the gender pay gap in Canadian medicine.

Please listen to the SGEM podcast to hear Dr. Cohen answer five questions and discuss the issue of gender pay inequity.

Five Questions about the Gender Pay Gap

Is the gender pay gap real?
Do women just work less (or less efficiently) than men?
What are some of the root causes of the gender pay gap?
What can we learn from other jurisdictions?
What can be done to close the gender pay gap in Canadian medicine?

The CMAJ article fits with the evidence presented at FIX19. It also is consistent with the study published a year ago that showed Ontario female surgeons made 24% less per hour than male surgeons. This pay gap persisted even after adjusting for various factors (Dossa et al JAMA 2019).

The Ontario Medical Association (OMA) has published a report called Understanding Gender Pay Gaps Among Ontario Physicians from their Human Resources Committee. It found that male physicians on average bill 15.6% more than female physicians even after controlling for a number of variables.

There was a recent study that looked at the 194 countries and the gender of the national leader (Garikipati and Kambhampati 2020). They found that countries led by women were associated with better COVID-outcomes. This is low quality evidence because it is an observational study that is pre-print (not peer reviewed) and we should not over-interpret the results.

This association between women leaders and good COVID responses was discussed in a debate about masks back in the spring of this year (SGEM Xtra Masks4All). There was a stronger association between women leaders and good COVID responses than to mandatory universal masking policies.

Conclusions to the CMAJ Article

“Women continue to be paid less than men in medicine. The gender pay gap exists within every specialty and also between specialties, with physicians in maledominated specialties receiving higher payments. The gap is not explained by women working less but, rather, relates more to systemic bias in medical school, hiring, promotion, clinical care arrangements, mechanisms used to pay physicians and societal structures more broadly. Progress in Canada will require a commitment from medical associations and governments to close the pay gap, starting with transparent reporting of physician payments stratified by gender. We need to go further as a professionto understand how gender, race, disability and other identities intersect to affect gaps in pay and then take action to address these gaps to realize the vision of pay equity for all in medicine.”

We need to ensure that everyone gets the emergency care they need, regardless of whether they identify as a man or woman. The emergency department is like a lighthouse. It is the one place in the house of medicine where the light is always on and will treat anyone at any time for anything.

The gender inequity discussion does dichotomize things into men and women. This is a false dichotomy. There are people who do not identify as a man or women. Gender is complex and on a spectrum. There is how a person identifies, expresses themselves, the sex assigned at birth, who they are physically attracted to and who they are emotionally attracted to. I would suggest that FBM is just the starting point and we need to take it one step further to Gender-Based Medicine (GBM).

The Gender Unicorn is a graphic representation demonstrating the complexity of gender and sexuality. We need to make sure that the house of medicine is not just inclusive and tolerant but accepting and welcoming to everyone regardless of how they identify.

The progression, in my opinion, should be from Evidence-Based Medicine (male dominated) to Feminist-Based Medicine (recognizing gender inequity) to Gender-Based Medicine (more inclusive) and ultimately to Humanist-Based Medicine (HBM). There are other inequities in medicine besides just gender. There are problems with race, religion, socioeconomic status, mental health, physical ability, etc.

In order to provide patients with the best care, based on the best evidence we need high-quality, clinically relevant research that is inclusive and representative of everyone; remove inequities for those who generate research and provide care at the bedside; and finally, recognize everyone has value and should expect and deserve great care.

The SGEM will be back next episode doing a structured critical appraisal of a recent publication. Trying to cut the knowledge translation window down from over ten years to less than one year using the power of social media. So, patients get the best care, based on the best evidence.