As a fourth year student in my last few weeks of medical school, I recently found myself in an interesting new course — negotiation skills for graduating medical students. As part of a push from accrediting organizations like the LCME, the final weeks of our medical education are being devoted to lesser-taught subjects in medicine — licensure processes, malpractice, wellness and resiliency training and contract negotiations. At the start of the lecture, a female friend turned to me and sarcastically quipped, “Now we’ll learn why women in medicine make less than men.” I laughed, but the comment stuck with me, and I listened intently to the rest of the day’s lecture hoping to catch some hint of the topic to which my colleague referred.
In 2015, the Institute for Women’s Policy Research published an alarming statistic: on average, women made only 79 cents for every dollar earned by men. Even more alarming, was the fact that when the study controlled for qualification or stratified by job title, the gender wage gap persisted. Unfortunately, medicine is not immune to the gender wage gap phenomenon. According to data from the United States Census Bureau, women make up one-third of U.S. physicians, but on average, make only $00.69 for every dollar earned by their male colleagues. This results in over $56,000 in potential wages lost for a woman in medicine each year.
In response to these statistics, researchers and policy makers are making efforts to identify underlying causes and possible solutions to the gender wage gap issue. Social science research has suggested that a major barrier to women’s advancement in the workplace is their reluctance to engage in the negotiation space, and negotiation skills have been targeted as key tools to help improve work equity and parity. As a result, a ton of energy has been poured into the question: “Why don’t women negotiate?”
A quick Google search for “negotiation” and “gender” returns some revealing hits on this topic. Statistics from one popular website include:
- In surveys, 2.5 times more women than men said they feel “a great deal of apprehension” about negotiating.
- When asked to pick metaphors for the process of negotiating, men picked “winning a ballgame” and a “wrestling match,” while women picked “going to the dentist.”
- Women will pay as much as $1,353 to avoid negotiating the price of a car, which may help explain why 63 percent of Saturn car buyers are women.
Simply put, women aren’t comfortable negotiating. We are, in principled-negotiation parlance, “avoidant” or “accommodating.” We have too much empathy, and not enough assertiveness — or something like that.
At first glance, the idea that negotiation tactics are male-gendered — and therefore that women would be at a disadvantage in that environment — is an appealing justification. The logic is simple: men have traditionally dominated the workforce, and therefore the workplace environment, including the negotiation space, is structured and permeated by “male” tendencies. Search queries on the topic of “women” and “negotiation skills” return dozens of articles with titles like “How to Negotiate Like a Man,” or “How to Stop Negotiating like a Girl.” The implication here is that to succeed, all women need to do is learn to be more like their male counterparts.
So, are we really our own worst enemies? Are women — through some combination of innate and learned behaviors — truly less suited to the negotiation environment? Or is something else going on?
On a deeper level, the idea that women and men have innately different approaches to social interaction and inter-personal relationships, and therefore approach negotiating differently, represents a popular and regressive viewpoint derived from pseudo-sciences like social Darwinism, sociobiology and biological determinism, which even the most academic communities have failed to shrug off. At its worst, these fields create a biological-based platform for prejudice, using tools like evolution and genetics to legitimize discrimination against women. This is part of the reason why considering the negotiation space as a traditionally male space — one that women have to ‘break into’ — has been accepted with such little critical response. The result is that women are being blamed for their lack of leadership roles and lower salaries.
Fortunately, there are some interesting counter-threads in this narrative, ones that are working to unravel the myth that income inequity is the result of women’s inferior abilities to negotiate. Studies have found that, while women may be less likely to initiate negotiations, when they do, they may be more successful. In one study, women who had previous experience with successful negotiating were considered better negotiators than men. Similarly, gender gaps in pricing tend to disappear when transparency is improved, suggesting that women may use market information more effectively than men.
On another level, it is important not to forget that negotiation capacity is not the only reason women make less than men. This is a gross simplification, and frankly, an excuse. And, it has important implications for medical practice. Research has shown that women in medicine make less than their male counterparts in almost every specialty across the board. Part of this may have to do with salary negotiations. But, there are other factors involved as well. A study looking at Medicare reimbursements by gender found that male doctors were paid 88 percent more than female doctors; men also saw 60 percent more patients, and billed for one additional procedure per patient compared to women. This suggests that male physicians may take advantage of Medicare’s fee-for-service model by providing more services. Over-treatment, as we know, is a primary driver of health care costs, as well as medical errors. At the same time, increased volume of services means less time spent with patients. Research has also shown that women physicians may spend more time with their patients, and are more likely to ask about important social determinants of health, such as family structure, job and social milieu.
Ultimately, the reality of income inequity in medicine is a complex and problematic issue; the solution will require more than simple “negotiations for women” courses.
Editor’s note: A version of this article was previously published on KevinMD.com.
Physician Guest Writer
New York University School of Medicine
Katharine Lawrence is an Internal Medicine resident in New York City. She received a BA in Anthropology from Vassar College, and a Master's of Public Health from the Mount Sinai School of Medicine. She attended FIU Herbert Wertheim College of Medicine in Miami, FL. Katharine's writing has appeared in numerous medical and literary journals, including Hektoen International, the New Physician, and KevinMD.