The gender pay gap is a persistent reality spanning Ontario’s health-care system. In the first of a two-part series, Dr. Clover Hemans, co-chair of the OMA Women Committee; Dr. Simron Singh, medical oncologist and member of the OMA Burnout Task Force; and Dr. Samantha Hill, cardiologist and OMA past president shed light on what’s behind the challenges female physicians face across their careers and how this hinders access to equitable and inclusive patient care for every Ontarian.
The gender pay gap is a persistent reality spanning Ontario’s health-care system. In the first of a two-part series, Dr. Clover Hemans, co-chair of the OMA Women Committee; Dr. Simron Singh, medical oncologist and member of the OMA Burnout Task Force; and Dr. Samantha Hill, cardiologist and OMA past president shed light on what’s behind the challenges female physicians face across their careers and how this hinders access to equitable and inclusive patient care for every Ontarian.
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Georgia Balogiannis: In this podcast the Ontario Medical Association looks at current issues of interest in health care. Spotlight on Health gives you all the straight talk. We're Ontario's doctors and your health matters to us. I'm Georgia Balogiannis for the Ontario Medical Association.
The gender pay gap is an unpleasant reality in many industries and is also pervasive in Ontario's healthcare system. In this first of a two-part series, physicians discuss the challenges that women doctors face in the healthcare industry and the ways that gender equality is manifested.
Dr. Clover Hemans is a family doctor in Oakville, co-chair of the OMA Women Committee and past president of the Federation of Medical Women of Canada. Dr. Simron Singh is a medical oncologist, Wellness Lead for the Department of Medicine at the University of Toronto, and a member of the OMA Burnout Task Force. Dr. Samantha Hill is a cardiac surgeon at St. Michael's and Sunnybrook hospitals in Toronto and a past president of the OMA.
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Dr. Clover Hemans: There is sufficient and robust evidence to indicate that the gender pay gap is profound. It's international — it’s not just in Canada, but we certainly have one here.
There has to be a first step, and so acknowledging that there's a gender pay gap is the first step. There are individuals who are actually, I've heard personally, that are in leadership positions that are still not convinced, or at least up until a couple of years ago, I heard with my own ears, some individual state quite clearly that the gender pay gap was bunk. This leader was a man, and so, as a man, it's sometimes hard to appreciate what you've not experienced.
Why does it matter that women are compensated less for sometimes, I'd say, not just work of equal value, sometimes work of better value? And why would it matter to society and to patients? For several reasons. The reality is, there are enough studies that indicate that women — where we're looking at gender binarily, and so, you know, male versus female —when you have more gender diversity on boards and in patient care, patients actually do better.
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Dr. Hemans: It's very hard to separate what my experience was in medical school and in residency from who I am, and I'm a black woman. Believe me, what I experienced would likely be a little bit different than what somebody who's predominantly Caucasian from a middle-class upbringing may get.
No path is straight, that I can tell you. You have to have not just the perseverance, but you kind of have to have the strength of will. But you know what happens when you have the strength of will? It's a problem when you're a woman. [laughs]
Dr. Hemans: Because you're going to be looked at as somebody who's stubborn, that can get in the way of you actually succeeding. This is so pervasive. Early. It seems to be okay when you start a job, since there's so much, I'm going to call it secrecy and a little bit vagueness, opacity. When they advertise a job, you rarely see how much the job is worth. It seems to be perfectly fine for them to offer that job at a higher rate to a guy. We're not well represented gender-wise, and we're super not represented gender and race-wise.
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Dr. Hemans: By biological pejorative, we are the ones that gestate and must recover from that. When you take individuals that do that out of the workforce, there is a period of time where their productivity or outputs are not in the system. That actually has a financial effect over time as well, when you consider that women in general do 100 minutes per day more childcare and housework than a man.
But I've heard it many times, when women who are working in hospitals who are doing a lot of call, or just long hours, and I hear other women say, “Oh my god, what kind of children is she raising?” Is she raising. “How are the children doing with all the time that they're spending here?” And they're saying that with some degree of censure, and you rarely hear that same censure applied to a man that's doing the same job.
So again, that's part of our socialization. We are geared to be more nurturing. You add all of that to the messages that get put across that also then make women less likely to apply, because they’re can't be both places. Gender bias is something that we're actually all socialized with. That starts early. Literally, it's talking about culture, we're talking about socialization. It's who we consider ourselves to be. And that starts pretty much from birth. And it's not something that's easy to change.
I think we actually do men a disfavour. There are a lot of men that would like to have more time with their children, and we prevent them from having that time. So, I think that's why there's a move these days to also accept that this is something that's reasonable, that they should be able to have this time without them being censured for wanting it.
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Dr. Hemans: Women's surgeons are paid about 24 percent per hour less, regardless of what specialty they're in. Why is there a difference? And by the way, some of this numbers, when you look at them overall before this net, it's as high as 30 to 60 percent. In fact, there is not one specialty where women, even if it's women predominant, make more than men. Not one.
Men or male-gendered physicians tend to refer more to the same sex in their specialties. Women tend to balance it. So, they don't necessarily refer more to women. If they do, it's probably 50… 52 to 50. But men, it's more like 75, 80 to 25, 20.[Text Wrapping Break][Text Wrapping Break]Who gets referred to you? As a specialist, are you going to get those that are less procedural or require more relational stuff, because they figure you're better at it, you'll spend the time, etc.? You probably will, but you tend to be paid for the procedure, so you're going to make less.
I'd say actionable and relevant differences in how women are compensated for their work remains to be seen.
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Dr. Simron Singh: If they knew the extent to which we're starting to understand now, the gender pay gap that exists in medicine, I think patients will be horrified. We want equity in terms of how we treat our patients. We want our patient experience to be reflective of the wonderful diversity we have in Ontario. And I think we want equity in how we provide care.
I'm very confident to say I think almost all patients would agree that this is a very important, in terms of the larger issue of equity that affects all of us, whether you're male, whether you're female, whatever color your skin is, whatever your race or your background is, whatever makes you unique to who you are, we want to be equitable parts of the system. And so, this issue is not isolated, it's part of a much larger issue that we need to continue to work towards.
The issue of male physicians being aware of the gender pay gap is an important one, and it's also a very timely one. In fact, I had a conversation with one of my male colleagues on Friday about this very issue. And they didn't understand. It wasn't so much that they were against the principle, but they didn't understand how this could happen.
They said, “Well, if I see a patient for X diagnosis, I get paid the same as my female colleagues.” But the idea of the referral bias — the way the, perhaps, the differences in the types of patients that are referred, and the differences, perhaps, in approaches to therapeutics that may exist — that all comes into play.
And so, I think it's a bit more of a complex issue. And what we really need to do to bring more male allies aboard on this issue is really having this discussion, having education, and not making it a blame-based discussion, making it one about education and understanding. And I'm very confident that the male physicians of Ontario want equity in terms of gender related pay as much as everybody else does. I think it's just a case of helping us understand the issue.
This is a larger issue. This is about how our system works and the principles and the basis of which our system works. So, I think there's a lot of advantages that can be gained in many areas.
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Dr. Samantha Hill: I think the reasons for the gender pay gap in medicine are multifactorial, I think they are contextual, I think they are situational, and I think they're very much built into the system. And unwrapping all of that means understanding it first and then being able to find ways that are fair to everyone involved to repair it.
I don't think it's going to be an easy fix. I don't think it's going to be a very rapid fix, unfortunately. It was a priority for me that we address the gender pay gap because over half of our incoming medical students are female, and over half of our doctors are female in a variety of specialties. And accepting a gender pay gap meant accepting that half of our population was underpaid based on their gender or their sex, and that does not sit comfortably with me.
From an even bigger lens, though, it also was a priority for me because I think that if we accept it as is, then it contributes to the demise of medicine as we know it. With more and more physicians being female, having them systematically or having us systematically underpaid means that the medical system is systematically underpaid. And that means that patients suffer at the end. So, my reasons for addressing it were, in fact, not personal at all. Um, despite being female, my reasons for addressing it were really about trying to help my colleagues and having a longitudinal vision of medicine in Ontario.
Why equity and diversity is important in medicine is because we know, and there have been many papers published that say that, when there is more diversity in any industry, you have more growth, you have more diversity of thought. And we know that in medicine, in particular, having physicians who come from diverse backgrounds, speak diverse languages, look diverse ways, makes patients feel more comfortable. And having patients see physicians who look like them, who sound like them, who understand them better, enables them to get better care.
Every single human in Canada should have access to equitable health care. And if the health care delivery and the health care recipients are stratified based on that diversity, that's systematically unfair and it leads to lower health outcomes.
So, if we don't fix the pay gap, then we are accepting that female physicians won't go into certain specialties or potentially women won't go into medicine at all in the next coming generations because they know that they can't be equitably and fairly paid.
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Dr. Hill: So, when I decided that I wanted to do cardiac surgery, I had a great rapport with the surgeons there and thought everything was great until I asked one of them to write me a reference letter. And without really thinking, I think, too much about what he was saying, said to me, “Well, you can't do cardiac surgery, you're going to want to have a family.” And I said, “What?” He said, “Well, you want to have kids.” And I said, “Yeah.” And he said, “Well, then you can't really do cardiac surgery.” And I kind of paused and I said, “Well, I guess we'll have to agree to disagree on that one,” or something along those lines. And then he sort of offered to write the reference letter, and I said, “No, but thank you.” Because at that point, I wasn't sure what the reference letter would say.
That was one of my very first experiences with the "hidden curriculum," as we call it in medicine — the still underlying degree of sexism.
I've seen a very strong relationship between trainee gender and trainee experiences in the operating room — being allowed to do more or less based on whether you were male or female, or perhaps it wasn't based on that, but it certainly correlated to it. And of course, opportunities that arise afterwards as far as either publications or being involved in various programs. And these, of course, wind up being very relevant for career advancement and career goals.
I don't think to any degree that there's a majority of physicians sitting around saying, “oh, women can't do this, or women shouldn't do this, or I'm not going to let women into this field.” But I do think our underlying view of how we see men and women — and I do tend to talk in binary genders, but I absolutely accept that this is probably even worse for people who are not from those binary genders — but how we see people, and our assumptions about gender and qualities and our interpretations of behaviors based on gender, are still very important in career opportunities, career expansion, and career success.
While more of the female cardiac surgeons, the female surgeons, will perform broad spectrum procedures, and therefore take the lower paying jobs as well as the low paying work as well, you see that less with the men. Not not at all — there's no absolutes in this, it's very fuzzy and very hard to differentiate, but we do see these trends. And so, if a given procedure pays significantly less than another procedure, but takes the same amount of time, that in and of itself is another pay gap. Someone has to do that work; it can't just not get done.
So, a lot of system level issues that don't really boil down to just gender but reflect the decisions that people make inherently with gender and with assumptions they make about gender. I don't think that there is so much of a "you cannot pass this level" line, as there are these giant gaps in skills and opportunities that we need to be able to get past that line.
And so, what I mean by that is, let's say you wanted a leadership position. Let's say you wanted to be able to do things in leadership — you would need expertise in communication, you would need expertise in corporate management, you would need expertise in being on a board, you need expertise in various subject matters. But if you've never been addressed or offered an opportunity in those, no matter how bright and how dedicated, how well tested you are — when you apply for these jobs, you're missing skill sets. And you can't blame the people hiring for hiring the person with the skill sets as opposed to the person without the skill set.
So, how do we fill in these rungs? How do we make that ladder more equitable for men and women? And that's a huge question, not just in medicine but in society at large. Until you can say that you see women, men, and every other gender equally distributed in society as they are in positions of leadership then we're still missing rungs and we still need to address that.
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Balogiannis: This podcast is brought to you by the Ontario Medical Association and is edited and produced by Jodi Crawford Productions. To learn more about the Ontario Medical Association, please visit oma.org.
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