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Ontario Medical Review
December 23, 2020
Stuart Foxman

This article originally appeared in the November/December 2020 issue of the Ontario Medical Review magazine.

Healing the gender gap

Why do female doctors earn less?

by Stuart Foxman 

Last year, Dr. Sharon Bal, a family physician in Cambridge, was interviewing for a position. A male physician asked if she, as a busy working mother, would have the time and attention for the role. Another time Dr. Bal, who is also co-chair of OMA Women, was preparing for a public town hall. A male administrator wondered if another male physician might be better suited to present. Why? Because he looks like a leader. 

Dr. Constance Nasello, an obstetrician-gynecologist in Chatham and a member of the OMA Women Committee, said that if female doctors are assertive, they’re told they are difficult. If they’re polite, they are told they aren’t decisive enough. She added that there’s a running joke that OB-GYNs aren’t “real” surgeons, as their patients are only women. “It’s not funny,” she says. 

Then there’s the dynamics of meetings. Dr. Clover Hemans, a family physician in Burlington and the other co-chair of OMA Women, said a woman’s voice often isn’t heard in meetings – not until another voice, usually a man, repeats what you said. Dr. Hemans said gender bias can affect career choices, advancement and salary.  

The three doctors were among those who shared their vignettes at “Healing the Gender Gap,” a webinar held on Nov. 27 as part of the ongoing OMATalks thought leadership forum. The event was moderated by journalist Anna Maria Tremonti of the CBC, and was co-sponsored by the OMA, OMA Women and the Section on General and Family Practice.  

In Ontario, women make up about 42% of all doctors, and more than half in certain specialties. Demographics tell us that by the end of this decade the province will have more female than male physicians overall. Women have earned their roles across practice settings. What they don’t earn—too often, is the same respect or income as their male colleagues. 

‘Healing the Gender Gap’ came on the heels of a report to OMA Council called “Understanding Pay Gaps Among Ontario Physicians.” It was the largest study of its kind in Canada. The report identified a 15.6% unexplained pay gap between male and female doctors (see “Behind the Pay Gap”). 

OMA leadership is committed to examining the root causes and working toward system-level approaches to solutions (see “Closing the Gap”). 

Disparities within and between specialties 

Kicking off the main presentations, Dr. Tara Kiran, a family physician, said “The gender pay gap is real. It doesn’t relate to women working less or less efficiently—those are common myths. It relates to the type of work we do and how that work is valued.” 

Dr. Kiran is the Fidani Chair in Improvement and Innovation and Vice-Chair, Quality and Innovation in the Department of Family and Community Medicine, University of Toronto. She described research that indicated an income gap between and also within specialities (higher-income ones tend to be male-dominated). One study found that male family physicians earn 30% more than their female colleagues, while male specialists earn 40% more. 

Even if women work fewer hours, that in no way explains the size of the gap, said Dr. Kiran, who’s a scientist in the MAP Centre for Urban Health Solutions at St. Michael’s Hospital, and an adjunct scientist at ICES. Dr. Kiran cited another study showing that female surgeons in Ontario earned 24% less per hour than male surgeons. 

Research in the New England Journal of Medicine also found that women give patients more of their time. That translated into 11% less annual revenue from visits than male doctors in the same practice. The difference was entirely driven by volume. Female doctors weren’t spending less hours per day, but more minutes per patient. 

The gap relates to sexism and discrimination throughout a career, says Dr. Kiran. In medical school, for instance, some women are dissuaded from entering specialties that are considered too demanding. Bias can continue in recruitment, starting salaries, negotiations, referrals and promotions based on the old boys network. 

Sometimes, it’s hard to even notice, said Dr. Michelle Cohen, a family physician in Brighton and an assistant professor in the Queen’s Department of Family Medicine. She likened the situation to a fish in water. In this case, structural inequities is “the water we swim in,” said Dr. Cohen, who writes about health policy and health equity, and co-chairs the Advocacy Committee of Canadian Women in Medicine.  

She noted that over a 30-year career, the gender pay gap amounts to $2.5 million. That’s a stark measure. Dr. Sharon Straus, Director of the Knowledge Translation Program and physician-in-chief, St. Michael’s Hospital, described other realities like trouble finding mentors, being less likely to be introduced as doctors and, in academia, receiving fewer invitations for talks and having your work judged more harshly. 

Then there are the microaggressions, such as inappropriate and unprofessional comments or behaviour. That’s like wearing down a stone, said Dr. Straus, a geriatrician and clinical epidemiologist. She feels those occurrences can be worse than a single egregious action, where at least something is usually done about those. 

These inequities are bad enough, and the situation is even worse for racialized and Indigenous female doctors. 

What can be done?  

Dr. Cohen highlighted the need for anti-oppression training in clinical groups and practices where you learn how systems of power and privilege interact. She talked about the need for fair and transparent hiring processes, with gender parity on hiring committees; disparities in fee codes is another part of the solution. And stop telling female trainees to go into family friendly specialties, said Dr. Cohen. 

Both she and Dr. Straus described the need for strong allyship. Dr. Cohen said we hear a lot about women leaning in, but women also often face a blockade of established networks. It would be helpful, she said, for more men to lean back. “What power can you yield to underrepresented groups?” she said. 

Dr. Straus added that part of being an ally is recognizing the unearned privilege that you might receive from society’s patterns of injustice and inequity. 

Dr. Gianni Lorello, a staff anesthesiologist at Toronto Western Hospital, and the inaugural chief diversity officer for the University of Toronto’s Department of Anesthesiology and Pain Medicine, said his mission is to provide a space and voice for all marginalized groups. 

Not only is that the right thing to do, but diverse health teams also result in better diagnoses and greater patient satisfaction, said Dr. Lorello, who’s also a member of the OMA’s Civility, Diversity and Inclusion Committee. 

In nine vignettes that were interspersed through the program, participants heard some personal experiences and reflections. “Women doctors work harder and are not treated fairly,” stated Dr. Aly Abdulla, chair of the OMA Section on General and Family Practice. He said pay gaps are systemic, societal and pernicious.  

Dr. Sharon Burey, a behavioural pediatrician in Windsor, called out the “chronic undervaluing of the work of women in medicine and across all sectors in society.” Dr. Burey, also a member of the OMA Women Committee, said that “gender equity is part of a larger issue of creating an equitable and just society for all.”  

And Dr. Nasello noted the rising percentages of female physicians. “Change is inevitable,” she said. “What we need most is respect.” 

Further reading 

Access the OMA Report titled Understanding Gender Pay Gaps Among Ontario Physicians.

Stuart Foxman is a Toronto-based writer.