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  • #31
    Originally posted by wideopenspaces View Post

    Yeah I'd guess somewhere around 10%. Still not cool. And it's easy to fix, at least in my specific job. We're all doing the same thing so should get the same pay with a standard differential for years of experience.
    At least at VA you can actually look people up! Actually someone should do a study on VA maybe it's already been done
    What are these titles they are being handed and how much more work does it require?

    Comment


    • #32
      Originally posted by AR View Post

      I personally agree that some gap exists. I think one problem with the topic is that when you start from a place that is completely nonsensical, you can't really have a good conversation. There is no way that the average male physician makes 28% more than the average female physician when corrected for the amount of work done (even if we attempt to correct for work that female physician would like to do but is prevented from doing for inappropriate reasons). Sure there may be specific scenarios where you see that 28% difference, but there is no way that it is he average.

      Do you think that the 28% figure reflects reality?
      It is funny that the shaky data on implicit bias is under reporting the problem but the shaky data on gender bias is over reporting.

      Comment


      • #33
        In our medium-size surgical subspecialty group, our newest partner is the only female and she generates the most RVU and has the highest income. She also works harder/more than anyone in the group in my opinion. She took only one week off after delivering her child. I might feel like this is too little and not good from a societal standpoint, but from a personal standpoint she is a partner and we have an RVU based model. We hired her knowing that there are patients who prefer a female doctor and she is able to capture this population, and she is thriving on this. There are certain ethnicity in the community that we think would prefer to see a doctor of the same ethnicity, so our next hire will probably to try and capture this population.

        ​​​

        Comment


        • #34
          Originally posted by Lordosis View Post

          It is funny that the shaky data on implicit bias is under reporting the problem but the shaky data on gender bias is over reporting.
          It depends on the data set.

          Also gender pay gap is far more specific than "implicit bias", which is somewhat amorphous.

          Comment


          • #35
            My group is “eat what you kill.” If a person sees more patients and does more surgery, they make more money. So either by working more, and/or being more efficient. Taking ER call pays extra. We have 20 in our group and 2 are women. The women are the 2 lowest earning in our group by far. Some make 1/8 of the highest-earning 4-5 guys, so forget about 28%; I’m talking about an 800% gender pay gap. I’m absolutely NOT saying that all women choose to work less and are less efficient, but the women in my group work shorter clinic hours than everyone else, see fewer people per hour, and are less efficient in the OR. They also choose to not take any ER call, which pays well and brings in more patients.

            I think there is an issue of discrimination by patients and possibly referring providers… some may not trust a female surgeon, and I imagine the same issue doesn’t apply to male surgeons in my field. This seems to be more of a societal issue however.

            Perhaps our group inadvertently gave the females worse clinic days? Perhaps we hired slower MAs and worse front desk staff for them, subconsciously assuming they’d be slower? Of course none of that would have been intentional but there could be some subconscious bias.

            I personally think that so many here are dismissive of it, because of the way medicine pays. Set $ per ER or anesthesia shift, a chest CT RVU doesn’t care about gender, groups that pay based purely on production, etc, doesn’t discriminate. So I am genuinely curious: what are the solutions to a gender pay gap in medicine in the above situations?

            Comment


            • #36
              Originally posted by VagabondMD View Post

              I generally agree with this...with the possible exception that I have seen mammography consistently devalued by partners. Mammography is a subspecialty that is (obviously) focused on women and has disproportionate participation by female radiologists.

              Otherwise, I agree. Radiology salaries, partnership tracks, and overall compensation does not discriminate. I have observed, over the years, when there are extra shifts to pick up, less voluntary participation by women, by their choice, and a greater likelihood of female radiologists (versus men) willing to pay others to shed shifts (especially nights, weekends, and holidays), but that is only my observation. Frankly, I think that they are smarter for doing so, as it promotes greater work-life balance, less burnout, better quality work and may contribute to a longer career. But if you are adding up dollar-and-cents, the women may fall behind because of this.
              Generally agree with this also however, as a breast imager (male), we are in tremendous short supply and we are valued for hospital contracts. I have never observed devaluation of the female or male breast imagers by my radiology partners in a long career. I've heard that used to happen but now, few want to be involved in breast imaging and are happy to let us do it. In fact, we could easily leverage that if we wanted to but we don't.

              Actually one could make a case that we get paid a premium since we don't do overnights, weekends and holidays and all partners make the same salary based on number of days worked.

              Never once have I see a woman paid any different than a man in our radiology practice. As Vagabond said, the only differential would be number of shifts worked, etc. and the women overall are indeed the smart ones imo.

              Comment


              • #37
                Originally posted by abds View Post
                My group is “eat what you kill.” If a person sees more patients and does more surgery, they make more money. So either by working more, and/or being more efficient. Taking ER call pays extra. We have 20 in our group and 2 are women. The women are the 2 lowest earning in our group by far. Some make 1/8 of the highest-earning 4-5 guys, so forget about 28%; I’m talking about an 800% gender pay gap. I’m absolutely NOT saying that all women choose to work less and are less efficient, but the women in my group work shorter clinic hours than everyone else, see fewer people per hour, and are less efficient in the OR. They also choose to not take any ER call, which pays well and brings in more patients.

                I think there is an issue of discrimination by patients and possibly referring providers… some may not trust a female surgeon, and I imagine the same issue doesn’t apply to male surgeons in my field. This seems to be more of a societal issue however.

                Perhaps our group inadvertently gave the females worse clinic days? Perhaps we hired slower MAs and worse front desk staff for them, subconsciously assuming they’d be slower? Of course none of that would have been intentional but there could be some subconscious bias.

                I personally think that so many here are dismissive of it, because of the way medicine pays. Set $ per ER or anesthesia shift, a chest CT RVU doesn’t care about gender, groups that pay based purely on production, etc, doesn’t discriminate. So I am genuinely curious: what are the solutions to a gender pay gap in medicine in the above situations?
                First, I commend you on your self reflection on why your group might have subconsciously done something. That add richness to the forum, and I think some nuance or at least honesty.

                Secondly, I don’t know how to solve it all, but I do believe transparency in data is essential. To me, some data at least allows for folks to start a conversation on something real, instead of “feelings” (even if they question the data, that can be worthwhile too!!)

                I keep seeing this thread updated. Interesting conversation.

                Comment


                • #38
                  I was away for the weekend and just got back to read all the comments. Very interesting and I appreciate all the different perspectives.

                  Couple things:
                  People in an employed model usually work for $/wRVU. This is something that can be negotiated. If men are better at negotiating (not at medicine!) then they could make dollars more/wRVU, which would account for some gender pay gap.

                  Secondly, wRVU for procedures on women tend to be lower. There was a study that looked at Urology vs. Ob/Gyn surgeries. The equivalent surgeries (like scrotal biopsy vs. vulvar biopsy, etc.) 80% of the surgeries on men were higher wRVU value than the female counterpart. Since women tend to pick specialities that care for women, here is another gender pay gap. VagabondMD I would be interested to know if the wRVUs for breast imaging is lower than another read that takes about equal time to read. (Would that be a CT of Chest? Obviously each physician reads at a different speed, but you get the concept).

                  abds I enjoyed your thoughts on the less efficient staff... Would your female colleagues work faster and get more done if they had the proper staff? I know I have an amazing MA and could not see the volume I do without her. My life would definitely be harder if she left me! Also, I agree with the referring physician thing... for instance, my female general surgeon does a ton of breast lumpectomies and my male surgeon does a ton of major abdominal surgeries. You know the wRVUs have to be different between the two... but my patients would rather see a female surgeon for breast surgery and that leave the male surgeon more free for major abdominal surgeries. This would dramatically change their ability to generate wRVUs.

                  Comment


                  • #39
                    Originally posted by SLC OB View Post
                    I was away for the weekend and just got back to read all the comments. Very interesting and I appreciate all the different perspectives.

                    Couple things:
                    People in an employed model usually work for $/wRVU. This is something that can be negotiated. If men are better at negotiating (not at medicine!) then they could make dollars more/wRVU, which would account for some gender pay gap.

                    Secondly, wRVU for procedures on women tend to be lower. There was a study that looked at Urology vs. Ob/Gyn surgeries. The equivalent surgeries (like scrotal biopsy vs. vulvar biopsy, etc.) 80% of the surgeries on men were higher wRVU value than the female counterpart. Since women tend to pick specialities that care for women, here is another gender pay gap. VagabondMD I would be interested to know if the wRVUs for breast imaging is lower than another read that takes about equal time to read. (Would that be a CT of Chest? Obviously each physician reads at a different speed, but you get the concept).

                    abds I enjoyed your thoughts on the less efficient staff... Would your female colleagues work faster and get more done if they had the proper staff? I know I have an amazing MA and could not see the volume I do without her. My life would definitely be harder if she left me! Also, I agree with the referring physician thing... for instance, my female general surgeon does a ton of breast lumpectomies and my male surgeon does a ton of major abdominal surgeries. You know the wRVUs have to be different between the two... but my patients would rather see a female surgeon for breast surgery and that leave the male surgeon more free for major abdominal surgeries. This would dramatically change their ability to generate wRVUs.
                    SLC, I'm not Vagabond but can help answer a little on the wRVU question. A screening mammogram has a lower wRVU than a chest CT but screening mammograms are the highest or next to highest wRVU/hr than any other imaging modality since they can be read faster. In the back of my mind, I sometimes wonder if the higher pay/hr for a screening mammogram is in part due to the higher liability of mammography than any other area of radiology (and most of medicine). However, when doing a diagnostic mammogram, it takes often take 2-4x longer and is a lesser wRVU than a screening mammogram. Makes no sense.

                    Chest CT's are higher wRVU but for the typical moderate paced radiologist, screening mammograms will pay higher/hr. A chest CT takes longer to read than a screening mammogram. Perhaps an abdominal ultrasound would take about as long to read as a screening mammogram, maybe a bit less time, and the wRVU is lower for an abdominal ultrasound compared to a screening mammogram.

                    Comment


                    • #40
                      Originally posted by childay View Post

                      At least at VA you can actually look people up! Actually someone should do a study on VA maybe it's already been done
                      What are these titles they are being handed and how much more work does it require?
                      Yeah, that is nice, it'll make it easy to show how much I'm being underpaid. He'll make people the medical director or something like that over different areas, in which they are over themselves and just doing their job ie medical director of psych consults or medical director of resident clinic. Doing the exact same thing they were doing ( and these positions are never made availablefor others to apply to), just being paid more. And then when they switch to a job where a made up title isn't available, they don't lose the extra money they were being paid. So they're doing the same job I am but somehow making 40k more because ???

                      Comment


                      • #41
                        Originally posted by wideopenspaces View Post

                        Yeah, that is nice, it'll make it easy to show how much I'm being underpaid. He'll make people the medical director or something like that over different areas, in which they are over themselves and just doing their job ie medical director of psych consults or medical director of resident clinic. Doing the exact same thing they were doing ( and these positions are never made availablefor others to apply to), just being paid more. And then when they switch to a job where a made up title isn't available, they don't lose the extra money they were being paid. So they're doing the same job I am but somehow making 40k more because ???
                        This is horrible. I am so sorry!

                        Comment


                        • #42
                          Originally posted by Hawkeye225 View Post

                          SLC, I'm not Vagabond but can help answer a little on the wRVU question. A screening mammogram has a lower wRVU than a chest CT but screening mammograms are the highest or next to highest wRVU/hr than any other imaging modality since they can be read faster. In the back of my mind, I sometimes wonder if the higher pay/hr for a screening mammogram is in part due to the higher liability of mammography than any other area of radiology (and most of medicine). However, when doing a diagnostic mammogram, it takes often take 2-4x longer and is a lesser wRVU than a screening mammogram. Makes no sense.

                          Chest CT's are higher wRVU but for the typical moderate paced radiologist, screening mammograms will pay higher/hr. A chest CT takes longer to read than a screening mammogram. Perhaps an abdominal ultrasound would take about as long to read as a screening mammogram, maybe a bit less time, and the wRVU is lower for an abdominal ultrasound compared to a screening mammogram.
                          The screening vs. diagnostic mammo is interesting... I often wonder who the he!! is negotiating for our wRVUs and have they actually practiced medicine before!

                          Comment


                          • #43
                            Originally posted by SLC OB View Post

                            Secondly, wRVU for procedures on women tend to be lower. There was a study that looked at Urology vs. Ob/Gyn surgeries. The equivalent surgeries (like scrotal biopsy vs. vulvar biopsy, etc.) 80% of the surgeries on men were higher wRVU value than the female counterpart..
                            FWIW, that study was massively flawed for reasons that I pointed out the last time you brought it up (link below). There is a follow-up post that I made after you posted the paper as well if you follow that link.

                            https://forum.whitecoatinvestor.com/...409#post263409


                            Originally posted by AR View Post

                            This strained credulity so much, that I had to look it up. It doesn't seem like this is correct.

                            First of all, the proper code for a scrotal biopsy is a skin biopsy as I don't think there is a scrotum specific code. Depending on how the biopsy is performed, it is worth anywhere from 0.66 to 1.01 wRVU (11102-11106)

                            There is a code for penile biopsy (54100) that is worth 1.9 wRVU.

                            There is a code for vulvar/perineal biopsy(56605) that is worth 1.1 wRVU.

                            So a vulvar biopsy is more wRVU than a scrotum and less than a penis. And the difference is nowhere near the magnitude of what you suggested.

                            It's possible you may be referring to different codes. If so, please post them.



                            Originally posted by AR View Post

                            So if you look at the article it says

                            Scrotum biopsy 55120 5.72 wRVU
                            Vulva biopsy 56605 1.1 wRVU

                            First of all, the difference in wRVU is still not what you said nor are the actual wRVU values.

                            Secondly, it looks like they are not doing a correct comparison of codes. The vulvar information is exactly what I posted. The CPT code for scrotal biopsy is different. The one they used is 55120, which is "incision procedures on the scrotum". Here is how that code is described:

                            "In this procedure, the provider removes a foreign body from the scrotum, the pouch that contains the testes, or testicles, after a traumatic injury, to prevent further damage to the scrotum and its contents."

                            That is quite clearly not a biopsy. You can also see that they use that very same code for "removal of scrotal lesion". Biopsy of a lesion and removal of a lesion are two different things. Yet in the paper they use the same codes for both when it comes to scrotum, but different ones when it comes to vulva.

                            If someone is using the code 55120 to code for a biopsy on the scrotum, they are either making a coding error or engaging in fraud. You can't compare an improperly coded scrotal biopsy to a properly coded vulvar biopsy.


                            Last edited by AR; 01-23-2022, 10:01 PM.

                            Comment


                            • #44
                              Originally posted by Larry Ragman View Post

                              Well, my question at least is what do you suggest be done about it? No kidding, at my work we work very hard to ensure there are no structural disparities. But real gaps persist mostly because of lifestyle choices. It is still true that women generally sacrifice career for families. But why is that wrong? Or at least, why should the implication be that the employer should do something about it?

                              I’ll give you an example of the sort of thing we sometimes think we should do. Every year or so we evaluate if we should have onsite child care. (We already offer very flexible hours.) We usually decide not, because there is plenty of private child care nearby. But after COVID I’m sure we’ll look again. My guess, we will not pull the trigger because we don’t want the liability of kids getting COVID at our workplace. So, predominantly (but not exclusively) the Mom’s will take advantage of our flex time to deal with kid issues. Again, is this wrong?
                              In my prior life, childcare was only one of the “Employee Wellness” issues. Everything from EAP to physical fitness etc. The childcare option was the top rated benefit from the female employees. The liability and standalone expense was huge. Plans were scrapped for onsite daycare and gym/recreation facilities. This was still a priority.
                              Solution was fund a huge expansion of a local YMCA. Provide family memberships for like $100 per year. Top notch facilities ran by “professionals” at the YMCA. Best “Employee Wellness “ benefit I ever experienced. They even added drop off and pickups from the schools later. Completely changed the gender dynamics of who picked up and dropped off the kids.
                              Feel free to recruit your mens league basketball team. That 6’8” engineer that played Div 1 might be a great choice. 30 ppg is a bargain!
                              Great PR, coimmunity investment.

                              Comment


                              • #45
                                Originally posted by AR View Post

                                You're making this sound infinitely easier than it is in real life.
                                Not implying anything about this is easy just trying to understand the specific issues in that particular case and what changes could be implemented for a more favorable outcome. As already noted there are many things in play including an element of discrimination, however on this forum we aren't talking about a single mom trying to buy diapers and keep the electric connected on her McDonald's salary. I would think members here could strategize and make changes if they are being treated unfairly for whatever reason.

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