Why is there a gender inequality in residency salaries?!?

I was thumbing through Medscape’s most recent residency survey, and I was shocked to see that men reported a higher income than women in residency!  No, I’m not a feminist, but my first thought at seeing a residency salary gender inequality was that there must be a variable that the survey didn’t control for…because that just doesn’t make sense. Gender inequality is a prevalent problem in the world, but the way medical training is set up, it does not seem plausible.

For those who don’t know, salaries for physicians in training is essentially fixed—you get raises for every subsequent year. There is no negotiation, because your salary is essentially a stipend that is predetermined by the hospital system that hires and trains you.

Medscape’s residency survey is just that—a survey. There are no controls or controlled variables like in clinical research. It is dangerous to make assumptions based on limited data. Why would the survey results show that men have a higher salary than women? Here are a few reasons I can think of:

Moonlighting. I knew many residents and fellows who decided to moonlight during their training. Pick up some shifts covering the emergency room or urgent care. Maybe a primary care outpatient clinic. Or even task handling for an internist office. Anything to pick up extra money. I knew both women and men who moonlighted during their training, but maybe men moonlight more?

No stratification between PGY classes. In general the stipend increases as you advance in your residency. Are there still more men in residency than women? Do men typically enter medical professions that have a longer training duration than women?

Are there more men training in medicine? Even back when I was in medical school, there was a trend towards a 50/50 split between genders, with some years women edging men. Is it still the case?

What other reasons might men report a higher income than women in residency?

Did you feel that there was an income discrepancy between genders during your training?

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  • The most likely explanation is that women favor shorter residencies (Pediatrics, OB-GYN) while men favor the longer residencies (orthopedic surgery, neurosurgery, radiology). PGY-5 and PGY-6 make more than PGY-3 and PGY-4.

    • Smart Money MD

      Definitely. Nowadays, we do see more of a normalization between genders in some of the longer training specialties like Radiology. I have a good friend (female) who did a 7-year gen surgery residency followed by 3 years of thoracic fellowship. Talk about a brutal course of training! Was it a good investment of time and money? Only time will tell.