Examining Gender Differences in CT Surgery: Is ‘Good Money’ the Same as ‘Fair Money’?

 A recent Annals article utilized data from the 2019 STS Practice Survey to compare responses between genders. The results were not only interesting, but also provoking and, possibly unintentionally, a call to action. 

Of all survey respondents, 8.1% identified as female (similar to data from the American Board of Thoracic Surgery that demonstrates 5% of delegates are female). Of the female respondents, 85.9% were working more than 50 hours per week (74.4% reported working between 51-80 hours/week; 11.5% reported >80 hours/week). No differences existed between genders for years of training, hours worked per week, or possession of additional advanced degrees. Women surgeons were younger than the male surgeons, had been in practice fewer years, and were more likely to practice in general thoracic surgery while men were more likely to have a mixed practice. 

When these factors were controlled (age, number of years in practice, type of practice), men were more likely to report higher salaries. For instance, women were 31% more likely to report a salary of <$600,000. In contrast, men were 31% more likely to report a salary of >$600,000. The full details of the salary breakdown can be found within the article. While a salary of >$200,000 is by many accounts considered “good money,” the question arises as to whether this is the same definition as fair compensation for equal work. “No one should get paid less for doing the same job because she is a woman.” (Lilly Ledbetter)

The workforce survey did not evaluate or compare factors that may be tied to compensation, including relative value units, rank, or geographic locations. However, studies previously have demonstrated that women physicians report lower compensation, even after accounting for age, experience, specialty, faculty rank, research productivity, and clinical revenue.

It is true that women physicians and surgeons are less likely to hold advanced academic ranks and titles. For all subspecialties, approximately 85% of all dean and department chair positions are held by men, and only 21% of full professor faculty positions are held by women. 

In terms of clinical abilities and outcomes, women surgeons perform equally well as men. A 2017 study that compared approximately100,000 matched patients concluded that patients treated by female surgeons had a statistically significant decrease in 30-day mortality, with similar length of stay, complications, and readmissions. 

What can we do to address these issues that are contributing to the gender wage gap and difficulty recruiting women to our specialty?

HelenMari Merritt-Genore, DO

This analysis also examined job satisfaction. Encouragingly, both male and female surgeons were generally satisfied in cardiothoracic surgery, yet female surgeons were less likely to report being “extremely satisfied,” and more likely to report burnout. We should passionately explore this outcome, especially considering that the female survey respondents were younger and earlier in their career than the male surgeons. Ask yourself if women physicians in your practice more commonly perform duties not directly tied to compensation or advancement like writing schedules for call, serving on committees, arranging conferences, or coordinating guest speakers. These uncompensated duties, in addition to a disproportionate amount of domestic tasks, may contribute to burnout and have been described as the “sticky floor” rather than the glass ceiling for advancement. This is according to several studies that have examined citizenship tasks within practices and the gender differences which may exist. Additionally, approximately 1-in-3 women in academic medicine have reported experiencing sexual harassment. Our own subspecialty data suggest that >80% of women in thoracic surgery have experienced some form of sexual harassment, which has previously been linked to physician burnout. 

What can we do to address these issues that are contributing to the gender wage gap and difficulty recruiting women to our specialty? Number one is transparency, and for this, I applaud the authors for publishing these data. This type of direct discussion must occur at national as well as institutional levels. 

Also critical is the sponsorship for leadership positions and promotion. Our society has been on the front line of leadership in this regard, increasing women in society meetings and leadership positions, involving male surgeons in #heforshe, and utilizing STS presidential addresses to focus on the benefits of inclusion and the advancement of women in our field. This should be commended and continued on national and local levels. 

In addition, the intolerance of sexual harassment, which should need no further explanation, is important. Read Dr. David Tom Cooke’s thoughts on sexual harassment within cardiothoracic surgery in “No Such Thing as an Innocent Bystander.” 

Other action items include the implementation and funding of strategies to address disparities, as well as the investigation and critical examination of pay structures. Lastly, tracking and reporting outcomes are imperative. 

While the 2019 STS Workforce Survey was not specifically designed for a complete and thorough comparison of female and male cardiothoracic surgeons, the ad hoc analysis helped identify serious issues within the specialty that require attention, dedicated conversations, and important action.

HelenMari Merritt-Genore, DO, is an adult cardiothoracic surgeon at Methodist Physicians Clinic in Omaha, Nebraska. She completed an integrated residency from The University of Texas Health Science Center in San Antonio, Texas. Dr. Merritt-Genore has clinical interests in minimally invasive CT surgery and surgical ablation, as well as a passion for surgical education. She holds several leadership roles in STS and Women in Thoracic Surgery.