Income disparities between the sexes have existed for decades in practically all fields. With the second wave of feminism that began in the 1960s, workplace equality dramatically increased. Within medicine, however, a sex gap still exists, most prominently within the surgical specialties, such as orthopaedics.
Even though women accounted for 49 percent of enrollees in medical school, only 5.7 percent of orthopaedic surgeons were women, according to the 2014 AAOS Member Census (Fig.1). Studies performed in other surgical specialties suggest that income and overall career satisfaction may differ between males and females and may be contributing factors to this gap between the sexes.
Income disparities have been documented within the specialties of primary care, plastic surgery, and colorectal surgery; however, not all of these studies accounted for hours worked. A survey of pediatric surgeons found that women overall felt an increased household responsibility, which could translate into fewer hours worked. A recent article in the New York Times reported that female surgeons make 71 percent of the salary of their male counterparts; the difference was mostly attributed to the lack of flexibility in hours worked and disproportionate financial gains for individuals willing to work longer hours. Thus, male surgeons, without the stereotypical household responsibility of females, might have an advantage.
In a 2009 study of medical students, patients, and practicing orthopaedic surgeons, 42 percent of those questioned reported that they had encountered negative attitudes toward female orthopaedic surgeons. Most often, these attitudes reflected a patient’s or colleague’s questioning the surgeon’s ability to meet family responsibilities. Based on these factors, female orthopaedic surgeons might be expected to have lower career satisfaction than their male colleagues. However, a 2012 report published in The Journal of Bone and Joint Surgery concluded that both female and male orthopaedic surgeons were equally satisfied with their career choice.
Our study and design
Although other surgical specialties have documented income disparities between sexes, orthopaedic surgery lacks a current study of this kind that includes both hours worked for compensation and overall career satisfaction. We developed a self-reporting questionnaire for practicing orthopaedic surgeons to assess the following:
- whether an income gap exists between sexes and possible reasons for any compensation differences
- overall career satisfaction in orthopaedics
Board-eligible practicing orthopaedic surgeons were recruited via email from the past 10 years of alumni lists from three orthopaedic surgery residency programs, the Ruth Jackson Orthopaedic Society, and the Massachusetts Orthopaedic Association.
In univariate analysis with salary, only sex (P < 0.0001) and age group (P = 0.0003) were determined to be statistically significant. The difference between reported salaries for male orthopaedic surgeons and female orthopaedic surgeons was statistically significant (P < 0.0005), favoring a higher salary for males. In bivariate analysis, the interaction between sex and age was also statistically significant (P = 0.0072).
This analysis confirmed that even after controlling for other collected variables, male orthopaedic surgeons reported higher salaries than female orthopaedic surgeons, and that difference was statistically significant.
We also attempted to assess whether career satisfaction was related to income. We found a significant association between higher income and a belief that male and female orthopaedic surgeons were being compensated evenly (P < 0.05), as well as a significant association between income and a belief that the individual personally felt fairly compensated (P < 0.0007).
Age and income
Age also interacts with sex and has an effect on income, generally reflecting a bell-shaped distribution. This may be due to the orthopaedist’s career arc. When beginning practice and building a patient base (ages 30 to 35), orthopaedic surgeons have lower salaries. Once they reach the 41–45 age range, most orthopaedic surgeons have an established practice with a good referral base and are in the prime of their career salary-wise. After age 45, many surgeons gradually begin to reduce their overall patient volume, which has a direct relationship with income.
Only salary (P < 0.0001) and hours worked (P < 0.001) were found to be statistically significant in predicting career satisfaction. Orthopaedic surgeons with the lowest salaries tended to be the most satisfied, while those whose salaries were within the range of $500,000 to $750,000 tended to be the least satisfied.
The demographics of the orthopaedic surgeons in lower salary ranges may provide a clue to their level of satisfaction. They are either in the first few years of practice or are older than age 45 (with many older than age 65). Younger surgeons are excited about building their practices and willing to balance work and life, while older surgeons may be willing to work fewer hours or have a lower volume of patients to maintain a better quality of life.
Based on hours worked, the most satisfied surgeons were those who worked less than 50 hours per week and those who worked more than 70 hours per week. Surgeons who worked around 60 hours per week had the lowest satisfaction levels.
A reasonable workweek that does not sacrifice quality of life seems to be in the range of up to 50 hours per week. As the workweek begins to exceed 50 hours per week and enters the 60 hours per week range, demand increases significantly at the expense of other activities that may be more desirable, such as spending time with family. As a result, satisfaction drops. Satisfaction among individuals who work more than 70 hours per week may remain high because they truly enjoy their jobs above all else and choose to work such a large number of hours.
Social factors (such as marital status or number of children) were also assessed. Female orthopaedic surgeons were more likely than males to be single or divorced and to have fewer children. This may reflect the higher social toll on women in orthopaedics who desire a family compared to their male counterparts.
Orthopaedic surgery can be a fulfilling career for both men and women, even though compensation for women remains less than that of male counterparts even after adjusting for hours worked. Despite compensation differences, both men and women in orthopaedics are equally satisfied with their career choice. Although the income gap between male and female orthopaedic surgeons should be addressed, satisfaction among female orthopaedic surgeons also needs to be emphasized to help attract more women to the field.
Emily Curry, BA, is a research assistant in the department of orthopaedic surgery at Brigham and Women’s Hospital. Elizabeth Matzkin, MD, is assistant professor, Harvard Medical School; chief, women’s sports medicine at Brigham and Women’s Hospital; and a member of the AAOS Women’s Health Issues Advisory Board. She can be reached at firstname.lastname@example.org
- Male orthopaedic surgeons have significantly higher incomes than female orthopaedic surgeons, even after adjusting for other factors, such as hours worked.
- This gap is concerning and further research is needed to identify ways to eliminate this sex-based income difference in orthopaedics to help increase the number of women in this male-dominated medical field.
- Despite the documented income gap, overall, both male and female orthopaedic surgeons are satisfied with their careers and would choose to pursue the same profession if given the option to do so.
Putting sex in your orthopaedic practice
This quarterly column from the AAOS Women’s Health Issues Advisory Board and the Ruth Jackson Orthopaedic Society provides important information for your practice about issues related to sex (determined by our chromosomes) and gender (how we present ourselves as male or female, which can be influenced by environment, families and peers, and social institutions). It is our mission to promote the philosophy that male and female patients experience and react to musculoskeletal conditions differently; when it comes to patient care, surgeons should not have a one-size-fits-all mentality.
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