The gender pay gap in medicine: A structural problem

In the German market economy, the pay gap between women and men is well-known. But how is the salary situation within the medical profession? Studies show the problem is complex.

A view from Germany on the salary differences between female and male physicians

In the German market economy, the pay gap between women and men is well-known. But how is the salary situation within the medical profession? Studies show the problem is complex.

In many market economies, pay gaps between women and men are a recurring hot topic. But the pay gap is not an unknown problem in the health and social services specifically. The German medical newspaper Ärzte Zeitung reported a salary gap of 20% between men and women in the national health sector in 2019.

Within the medical university landscape - the pay gap is becoming increasingly apparent. A study by the network Frauen- und Geschlechterforschung NRW (Women and Gender Research NRW) shows that North Rhine-Westphalian universities with a medical focus are leading in terms of salary differences: On average, female professors there earn €994 less per month than their male colleagues. The study also showed that professorships are predominantly filled by men, while the proportion of women is higher among physician students.

According to Dr. Christiane Groß, President of the German Association of Women Physicians (Deutschen Ärztinnenbundes or DÄB), there is basically no difference in medical salaries in the case of equal qualifications, but rather structural inequalities. In an interview with the Ärzte Zeitung, Dr. Groß cites the choice of medical subjects as a possible reason for a pay gap: "Women work more often in so-called soft subjects, which include psychotherapy, psychiatry, pediatrics and also general medicine. Men, on the other hand, are more often found in fields of technical medicine, such as radiology or laboratory medicine". Dr. Groß also sees different gender behavior patterns in the outpatient sector as an additional factor for salary differences: "Women take more time for communication. This in turn is not rewarded in our healthcare system, although there are studies that show that chronically ill patients benefit from this".

The COVID-19 crisis exposes many pay gap and career opportunity issues

Structural inequalities are a major factor in wage differentials in the German market economy. According to the German Federal Statistical Office's (Statistischen Bundesamtes) survey for 2020, women - including in medicine - are predominantly employed part-time. In 2018, almost every second woman in employment (47%) between 20 and 64 years of age was working part-time, whereas only 9% of men were employed. The main reasons cited for working part-time were caring for children and people in need of care (31%) or other family or personal obligations (17%).

The DÄB points out that especially in the COVID-19 crisis many of the problems surrounding the pay-gap issue are increasingly exposed and the pandemic is used as a justification for the many delays for the measures that should be finally taken in the current legislative period. Therefore, the DÄB makes two main demands to politicians: to improve working conditions and career opportunities for women in health care professions and to intensify gender research in medical and social issues. Dr. Groß remarks: "In the German health care system, 75% of the employees are women. It is feared that the COVID-19 crisis will not only mean a temporary additional burden of family responsibilities for women. The pandemic could lead to fundamental regressions in equality if the decision-makers do not take immediate countermeasures.

Senior physician and head physician positions - also possible part-time?

In principle, a reciprocal development can be observed in the healthcare system: Although more than seventy percent of all prospective physicians at medical schools are women, fewer and fewer women are to be seen in medical management positions. Prof. Dr. med. Gabriele Kaczmarczyk, Vice President of the DÄB and head of the Women on Top study, remarks: "The nationwide average of women in leading positions in university medicine is only ten percent and senior physicians are represented nationwide in university medicine with thirty one percent.” However, the fact that very few women end up on chairs, hospital directorates or department head positions is hardly known to the general public. Dr. med. Christiane Groß sees no basis for a "men's quota", as demanded by some male colleagues: "Let's remain realistic: Nationwide, the share of women among working physicians is currently around 45 percent - extrapolated from the previous growth rates, female physicians in clinics and practices will be represented in line with their share in the population in about ten years at the earliest".

So what measures could help to realistically implement a quota of women in management positions and thus counteract the gender pay gap? In a recent interview with the German news portal “Finanzen”, Dr. Groß explains a proposal put forward by the DÄB: "to counteract the unequal career opportunities, we need better care for the children of medical professionals and the possibility for female physicians of being able to exercise senior physician or even chief physician positions on a part-time basis. After all, the compatibility of family and career prevents many young female physicians - but also male physicians - from wanting or being able to climb the career ladder”, added Dr. Groß.