According to “Why Aren’t More Women Doctors in the Top-Paying Specialties,” less than one in five women physicians are practicing in the top five highest paying specialties.

Based on data gathered in the 2020 AAMC Physician Specialty Data Report, women comprise 6% of orthopedic surgeons, 8% of interventional cardiologists, 10% of urologists, 17% of plastic surgeons, and 18% of otolaryngologists. In the Medscape Physician Compensation Report 2021: The Recovery Begins, plastic surgeons are reported to earn an average of $526,000 annually, making that the highest-paying specialty, followed by urologists at $427,00 annually and otolaryngologists at $417,000 annually.

In contrast, women are the majority in lower-paying specialties, like pediatrics, at 64%, obstetrics and gynecology, at 59%, internal medicine, at 53%, and endocrinology, at 51%, according to the AAMC data. The one exception for women is dermatology, at 51% and an annual pay of $394,000.

Physician researchers and leaders in the highest-paying specialties point to four main factors for women avoiding these same specialties.

The first and most telling factor is that women are attracted to specialties that have more women in faculty and leadership positions. In an earlier PMC study, for instance, obstetrics and gynecology had the highest proportion of women department chairs, at 24.1%, and vice chairs, at 38.8%. Pediatrics had the highest proportion of women division directors, at 31%, and residency program directions, at 64.6%.

The remaining three factors tell much of the same story: women tend to prioritize their work/life balance over pay, women residents may be deterred from the highest-paying specialties because of gender discrimination or sexual harassment, and longer training periods for surgical specialties may be a deterrent for women who want to have children.

In a PMC study from March 2020, Representation of Women in Authorship and Dissemination of Analyses of Physician Compensation, it’s stated that physician gender pay gaps persist in the US despite an impressive body of research spanning more than 25 years and adjusting for potentially confounding factors, including rank, years in practice, practice type, specialty, parental status, and hours worked. The hypothesis was that women physicians were disproportionately represented as producers and disseminators of pay equity research and were largely unfunded for this work. The study suggested that men need to use their larger representation within academic medical leadership to help drive change and speed up progress in addressing compensation disparities.