Finding solutions to the gender pay gap

The gender pay gap is an unpleasant reality in many industries and is also pervasive in Ontario's health-care system. In this second 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 continue their discussion on the gender pay gap in medicine and describe what is currently being done to tackle inequality. 

Transcript

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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 second of a two-part series, we look at possible solutions to the gender pay gap and what is currently being done to tackle inequality in Ontario's medical community.

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. Simran 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's a gender pay gap in medicine. When this came up, there were a few men that asked me to help them understand it, but they actually asked with a true and authentic desire to understand. And so, when I could explain it to them, they were actually completely supportive.

You need to put women on boards, and on hiring committees, and on places where you're looking at medical educators, and that includes the surgical specialties, because when you appoint women to this, the type of individuals that you get attracted to it are actually more women, and they're more diverse in their thinking. And that's always better for the patients.

We need to have diversity far more than just gender— you got to have more black, indigenous, people of colour everywhere. We got to have more people who are not suffering from this ableism that we have, this ageism, this genderism, the sexuality-ism. When you have more people at the table who understand the lives and the experiences of those that we've been privileged to look after, you can provide simply better care, because you at least have an ability to understand where they're coming from.

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Dr. Hemans: Why would I talk about putting people in positions of leadership? Because that's really what I'm saying: put women — particularly BIPOC women, so diverse women — on committees, in places where decisions are made.

So, if you want change to occur, you cannot wait for each, an individual, to sort of get a light bulb moment that says, “oh my goodness I have been part of this whole — I'm going to call it cultural of unfairness — I'm going to change this.” That doesn't work. It may work when it's a one-on-one, but if you want to make big changes, you have to have this happen at a policy level. They have to be at a place where they can make change that is actionable on a large number of people.

When you're appointing people to boards and hospitals, in order to make change you need these peoples who have experience, both lived and otherwise, at the table to say, no actually, this isn't going to work. Or yes, actually, this may have more of an effect than you think. Have more minds being able to have more conversations/discussions, reflections — you'll make better decisions that affect people of all types.

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Dr. Hemans: Whenever and wherever you have an opportunity to meet, learn from, and reflect in respectful ways with people, you gain a potential ally that can spread the word and then help their people understand the story. Allies are, you know — how often do you win a war without allies, to put it that way? I don't want this to be a war. I want this to be something that's considered a wave or a change where everyone gets an opportunity to be their best self.

When you are your best self, you actually can present yourself in such a way — because we are supposed to be in a nurturing and healing profession — that means that the people to whom we're honored to help along their health journey and be a partner in their care, get the best of us. Which means, I would hope, that there would be better outcomes because we're listening better, we're hearing where they're at, and we're being compensated for it fairly, and we can give back, as opposed to feeling oppressed and worried about where we're at and pressured. A lot of that can be alleviated when people are able to be their best selves.

I would say, at the end of the day, allyship is just another word for building coalitions. And those coalitions, by the way, cannot simply reside in the corridors of medicine. We need to reach out to patients and other health care workers who share the same space and have the same goals in order to get this right.

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Dr. Hemans: We know that women are actually more than 50 percent of medical school class now, so they're going to be out there. I would say, for women, you're worth it, your work is worth it, do not settle. If you want to succeed, be part of a collective where you have supports from a diverse area and where you provide the same. It cannot be performative. It cannot be one of those statements where we say we're going to do something and nothing happens. But I'm also a bit of a pragmatic person, so I recognize this is not just something that — it's aspirational. I don't want it to be aspirational! I need it to be actionable.

It's not going to be easy. There is a lot of work involved. I don't know, I have a spark of optimism, but — I feel like doing that finger to eye — I'm going to be watching and I will not be alone.

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Dr. Simron Singh: When we need to think about dealing with the gender pay gap, we need to think about big picture issues, things about, like, should we have central referrals? Should we — and that might be good for patients, in that wait times would go down and access to care would go up. So, there's probably multiple gains to be made by dealing with this issue, the equity issue, the resource issue, the professional fulfillment, and the burnout issue. It's such an important issue in so many different realms.

We need to take a very active approach in supporting women in academic medicine and try to address some of these gender equities. Some of this might be policies that encourage diversity, transparency, accountability, public review of stats, indicators that show that we value diversity, that we value a mix of people in all different specialties. This may be implementing governance committees, having proportional representation on committees, making sure that diverse voices have voices in terms of how we do things.

I think we have to move towards organizations that support flexible environments. And this, again, is good for everybody. When we talk about flexible work life balances, we understand that there's unconscious bias that exists, that we have to deal with that. We offer things like childcare at the workplace and childcare at conferences. We ensure that opportunities are available to all.

And then I think we have to really concentrate on mentorship — having strong mentors in terms of career development, in terms of professional activities, we utilize things like virtual platforms to allow more flexibility. And we understand that people have different career paths, and we have to embrace that and celebrate that and support people in their different career paths to be able to achieve success depending on their individual life circumstances. And I think the more we build that basic level of equity into our system, we'll have a healthier workforce, we'll have a happier workforce, and we'll deal with some of these issues like gender pay gaps and gender equity.

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Dr. Singh: I do think having gender allies in trying to deal with this issue is very important. Personally, this issue I find is very important to me, simply one of equity. I think when we think of equity in our healthcare system, and we think of equity in our society, we have to recognize that that comes in many faces and different forms, and we all have to be working together to get to a sustainable, equitable, fair system that works for all of us, both providers and patients in our healthcare system.

The other reason that this really matters to me, besides being the right thing to do to be an ally in this issue, is it revolves around wellness. And I think what we're understanding now is when we're trying to deal with burnout and we're trying to provide a safe, secure, and sustainable, fulfilled environment for health care providers, wellness is very close aligned with equity, diversity and inclusion. And so, when we have issues like the gender pay gap, that really makes it very difficult for us to enable what I talked about in terms of professional fulfillment.

So, I do think we have to work together to solve this issue so that we can improve the wellness of all of us and create a more sustainable healthcare system and one that people want to be part of and are proud to be a part of. I'm confident as we have this discussion more, and as we continue to educate on this issue, the number of male allies in this area is going to continue to grow.

I do think what is really important is that this is a symptom of some of the issues of how our healthcare system can be improved, and that's both from a provider and from a patient level. And I think when we examine some of these issues and we bring this equity lens into it, we all benefit. Patients benefit, providers benefit, payers benefit. It's really a win-win situation here.

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Dr. Samantha Hill: The fee schedule is a behemoth. It is antiquated. It has grown like an old hospital that just kept having these things added to it, as opposed to being designed initially with the future in mind. And the fee schedule is inherently part of fee-for-service medicine. The question we need to ask even before that is, is that the right way to pay physicians anymore?

There's two generalized ways to pay people, one is fee-for-service and one is a salary. And that's true across any industry as well as it is medicine. You can pay by cash, or you can pay by the job for the period of time. Paying salaries encourages more depth of care. Paying fee-for-service encourages more numbers of care. And that is just human nature. We've seen it everywhere. And we know that that's true.

The best model for physician payment is likely some combination of the two, where you have a base salary or base capitation model that allows for that depth of care, but you also have incentives in order to encourage more numbers. The fear in switching to salaried models is that physicians will work less. I don't believe that to be a true fear. I think most physicians just want to take care of the patients and get adequately paid.

The fee-for-service model involves a lot of bureaucratic support. And I wonder if we could remove some of that bureaucracy and re-inject that into the healthcare system, if that wouldn't be better for patients.

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Dr. Hill: One of the things that we would need to do is actually understand how long different procedures took and what the limitations are in where they can be done. Because we know that there are also gender gaps in location of practice and there are gender gaps in setting of practice. And all of these things would need to be balanced against each other.

There are numerous physicians who still don't believe that the pay gap exists, who still don't believe that it's a reflection of anything other than choices that individuals have made, and who still believe that those choices are completely free and not biased by society and opportunities. So, we have to address that, and have to make sure that people understand before you can go around trying to really solve it in systemic fashion. But we can't wait for that understanding to start solving it because we might be waiting forever, unfortunately.

And so, when we look at the issues around gender care of children and households — and elderly family members, as well, is also an issue — we see it in medicine the same as we do everywhere else. It's not just money, because money is helpful but it doesn't solve the problem. It's the actual resource and the availability of the resource. And those are the things that we need to start looking at is, how do we make things easier and fairer? Yes, from a financial point of view, but also from a resource and opportunity point of view.

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Dr. Hill: More and more patients don't have family doctors. More and more doctors are looking for ways to leave. More and more people who graduate family medicine are looking to not practice comprehensive longitudinal family care. And as we see the collapse of family medicine, it's going to spiral into specialist care as well. And the viral effect that's going to have on health care in Ontario is, I don't think I'm overusing the word if I say, kind of terrifying.

I'm not very optimistic that much will have changed in a concrete level a year from now. I just think the problem is too multifaceted for this one change to make a large and concrete difference. 

That being said, we started this conversation by talking about how elated I am that we are beginning to make those changes and beginning to acknowledge it. And my hope, my fervent hope, is that it continues to build steam as it rolls downhill — in this case it's uphill, but it continues to build steam. And that as more people are talking about it, as more efforts are made, that the limitations to what we can do in the current setting become more obvious, that the gaps in fixing the problem become more obvious, and that as the understanding builds, the opportunities to effectuate change and the opportunities to fix the problem increase. And as those opportunities increase, hopefully people take advantage of them and we make things better because incoming generations deserve that, our children's children deserve that. 

And again, I'm not just talking about the physicians, I'm talking about our patients. At the end of the day, I'm talking about the care that our patients get, and that patients should be able to get care from people who look like them and people who sound like them and people who think like them and people who understand them. And anything that we can do to empower that vision is worth doing.

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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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