First the good news: Dermatologists are among the highest compensated medical specialists in the US. According to Doximity’s First Annual Physician Compensation report, dermatologists are essentially tied for sixth-highest compensation, neck-in-neck with plastic surgeons at an average of $420,000 per year. Dermatologists make nearly double what family medicine doctors make ($231,000), and nearly two-and-a-half times what the lowest earning specialists make—pediatric infectious disease specialists earn, on average, $186,000.

The Doximity figures are somewhat higher than those reported in the Medscape 2017 Physician Compensation report, which pegs dermatologists’ average income at $386,000, but there are parallel trends. More good news: Medscape’s Lifestyle Report ranks dermatologists as the nation’s happiest physicians at work, and tied for second place for outside of work happiness.

Dig a little deeper, though, and the picture is less rosy. While male and female dermatologists have similar rates of outside of work happiness, there’s a discrepancy. Half of male dermatologists (49 percent) are happy at work, but only 39 percent of female dermatologists say the same.

If female dermatologists need to pinpoint a cause for unhappiness, it may relate to a gender-based wage disparity evident across medicine and within dermatology. Doximity’s report shows that nationally the average female physician earns 26.5 percent less per year than a male physician. In dollars, the average female doctor makes $91,284 less than the average male doctor. Within dermatology, the disparity is less extreme, but still significant: 17 percent. While the average male dermatologist earns $448,794, his female counterpart earns $372,103.

According to Joel Davis, Vice President of Strategic Analytics at Doximity, the gender pay disparity was a striking finding. “We wanted take a look at differences across segments of the populations we were looking at. And probably the most striking conclusion we came to was around gender differences in physician pay,” he says.

Besides sex, the Doximity survey found that geographic location also has a significant effect on physician earnings, though it’s hard to find clear trends. For example, some Eastern metropolitan areas, such as New York City, Atlanta, and Washington, DC have the highest wage gaps, while Philadelphia, Baltimore, and Boston have some of the smallest gaps.

“Our big takeaway from the report itself was just how variable physician compensation can be at the local level. And I think it’s really reflective of our healthcare system, and how different markets behave because of the different dynamics at play,” Mr. Davis explains. Areas with large academic centers tend to have lower average compensation rates, and that’s not surprising, Mr. Davis says, since academic physicians tend to earn less than non-academicians.

Why the Gap?

It’s unclear why women in medicine continue to earn less than their male counterparts. The Doximity survey did not look at causation. But LindaSusan Marcus, MD, a dermatologist in Wyckoff, NJ, has some ideas.

“There’s still an ‘old boys’ club mentality in medicine,” says Dr. Marcus, who is on the Board of Directors of the Women’s Dermatologic Society. “Men tend to refer to other men, at least that’s my experience.” There are still more men than women in family and general medicine, and men interact on the golf course and country club or in other social settings, so referral patterns may reflect this familiarity.

Perhaps more troubling, Dr. Marcus believes that the general public overall values male physicians over female ones. “It’s hard to change public perception,” Dr. Marcus says. “Even in this day and age, some patients believe a man isn’t going to hurt them…Some female patients will either come or not come to see you because you are a woman.”

Past attempts to explain the gender pay gap have focused on different work patterns for men and women. One argument posits that if a woman takes time off to have children or care for them she will accrue less practice experience and therefore may earn less, relative to a man who started his career at the same time. Critics see flaws in the logic.

The Doximity study attempted to control for a motherhood effect. “We did control for things like hours worked per week. And we controlled in these particular statistical measures for geography, as well, and for years in practice,” Mr. Davis says. “So, to simply say men are working harder, longer hours, or part-time versus full-time—we only looked at full-time positions here—so, that doesn’t fully explain the difference. Controlling for these factors did decrease the average gap slightly, but it doesn’t fully explain that entire gap.”

Men and Women Do Things Differently?

Dr. Marcus would like to see reliable, current statistics on practice patterns in dermatology. If a greater proportion of men perform surgical procedures, which are more complex and better reimbursed, that could explain some of the pay discrepancy, she says.

As practice consolidation and large practice models continue to proliferate, men may earn higher compensation as managers and executives, Dr. Marcus speculates. “I don’t know any women who are heads at a big group practice,” she says. If women dermatologists in general tend to favor solo practice—and Dr. Marcus suspects they do—women may be limiting their income potential relative to men in large groups.

“We have seen hypotheses around there being differences in the type of practice from a private practice versus a fully employed position, although I haven’t seen great data particularly within the physician space that backs that up,” Mr. Davis maintains. “That’s more of a hypothesis.”

Finally, negotiation skills could be an issue, Dr. Marcus suggests. Mr. Davis agrees. “There are other academic studies that have looked at this particular issue across other industries. We don’t fully know if it applies to medicine, specifically. But they’ve found that things like differences in negotiation tactics during compensation package negotiations have had impacts on differences by gender,” he notes.

Having data, such as the Doximity salary data, can be useful, Mr. Davis asserts. “There are a lot of professional associations, group practice associations, and other industry associations that organize and share this data at the organizational level. But if you’re an individual doctor walking into a new position, you don’t have access to the same information,” he points out. “I think it’s good to be well-informed and to know what your potential worth is, and then use that information as part of the negotiating process.”

What Now?

There’s no readily apparent solution to the gender wage gap in medicine or dermatology specifically. When Practical Dermatology® reached out to the AMA for comment on the physician wage gap, media relations deferred to the AAD, which does not have an official position statement on this issue.

For her part, Dr. Marcus is optimistic that the pay disparity will decrease. Women are well-represented in dermatology today, especially in the population of younger doctors. “There will be more female doctors, especially in dermatology,” Dr. Marcus states. “Things should be changing.”