Shooting The Messenger On Part-Time Female Physicians

Tell the truth these days (or come close to it) and your assured destruction at the hands of the feminist lynch mob will soon ensue. Take Dr. Gary Tigges, M.D., P.A., who recently said of the alleged gender gap in pay among physicians,

Yes, there is a pay gap. Female physicians do not work as hard and do not see as many patients as male physicians. This is because they choose to, or they simply don’t want to be rushed, or they don’t want to work the long hours. Most of the time, their priority is something else … family, social, whatever.

Nothing needs to be “done” about this unless female physicians actually want to work harder and put in the hours. If not, they should be paid less. That is fair.

Of course, this yielded a pointless apology from him, a dumb parody piece (uncharacteristically) from Gomerblog — and the usual horrified objections disconnected from any actual rebuttal. Take this one from the American Council of Science and Health, by Jamie Wells, M.D. Mostly indignant offense-taking, she finally settles down to marshal something resembling an argument. And by "resembling", I mean just that, because it isn't much of one. For instance:

Dr. Tigges' misguided statements, out of step with more than a decade of data that disputes his biased assertions demonstrating that female physicians are not only as good as their male counterparts but in many instances provide higher quality care with better outcomes, are commonly held beliefs throughout the healthcare system, particularly by those in management and administrative roles (see here and here).

But wasn't the issue compensation due to time spent in patient care, not administrators and managers? Okay, let's keep going. Maybe she provides something of substance anon.

Another example that is standard fare for those subscribing to the Tigges way of thinking is that more women physicians work part-time. The reasons for this are often mischaracterized as "their choice." This is often not the case. Practices don't have to cover benefits or pay as much for part-time, so they offer it instead which uniformly results in full-time work for part-time pay. Changing jobs or accepting the reality of seeing more for less until something better comes is a mainstay dilemma for countless women.

This word salad rebuts not at all Tigges' assertion that women see fewer patients. Perhaps it is not their fault. But so what? Earlier, she complains of "the perverse payment incentives of the RVU (relative value unit) system here which values low quality, high volume patient mill type medical practice." All these things may be true. But, again, they do not form a counterargument.  At last, she drags out the big guns, from something called Equity Quotient. There, we learn

• Of 446 major U.S. occupations, physicians have largest median gender-based pay gaps; in some subspecialties, as much as $90k (Wall Street Journal 2016)
  
• Over $9,000 per physician/per year is spent by healthcare organizations due to gender inequality — cost accrued from attrition, burnout and litigation (discrimination/sexual harassment).
  
• Total cost of recruitment, on-boarding, lost revenue, about $400k (up to $600k) for a single hospitalist

At last, an on-point citation with numbers! Unfortunately for Equity Quotient and Dr. Wells, the underlying 2016 Wall Street Journal story buttresses Dr. Tigges' assertion, not hers. The devil is in the details (paywall, emboldening mine):

The biggest gaps in many white-collar professions don’t easily lend themselves to legislative remedies. In fact, the Journal’s findings belie policy makers’ hope that the most-educated women would lead the way in shrinking the gap. Currently, more women than men graduate from college.

Wage transparency—requiring employers to report salary data—is “just not going to move the needle much,” says Claudia Goldin, a Harvard University economics professor and one of the country’s foremost scholars on gender and pay. Prof. Goldin found in a 2010 paper that men and women earned almost the same salaries right after receiving University of Chicago M.B.A.s. At least a decade after graduating, the women earned 57% of their male classmates.

The main factor, she and her co-authors concluded: Women became mothers, interrupted their careers and eschewed lengthy hours that generated higher paychecks. “These particular occupations,” Prof. Goldin says, “are not very forgiving of taking time off and having kids.”

The Journal’s analysis of Census Bureau data for the five years through 2014 found male doctors working full time earned about $210,000 annually on average. Female physicians made 64% of that, about $135,000 a year. Among personal financial advisers, men took in about $100,000 while women made about $62,000.

Many white-collar jobs give substantially larger financial rewards to those logging the longest hours and who job-hop often, phenomena that limit white-collar women who pull back for child-rearing. Researchers on the topic say ingrained workplace cultures also impede women’s earnings.

What those "workplace cultures" are, the unnamed researchers don't say later in the article, but one suspects it has to do with the expectation of long hours, among other things. As with the overall and principally bogus "pay gap", hours, continuity, and specialization produce higher returns. A multivariate analysis based on specialty, time spent on the job, and continuity of employment would be useful. Too bad we don't appear to have it.

Previously: The Crisis of Part-Time Physicians