Is there equal pay in healthcare? Not if you are a doctor

Last year, for the latest release of data from its annual survey of hourly earnings, the Office of National Statistics (ONS) announced a continued closing of the pay gap between men and women in the United Kingdom. By April 2011, the difference in median hourly earnings between men (£13.11; €16.40; $21.10) and women (£11.91) in full employment stood at 9.2% (of men’s average pay)—a drop of one percentage point compared with April 2010.1 2 At this rate, by 2021 women can expect to be on a par with men—a mere 51 years after the Equal Pay Act passed on to the statute book.

Unfortunately, a change in methods led to the ONS publishing revised figures in March 2012, The change increased the 2011 gender pay gap to 10.5% and makes comparison with 2010 figures impossible.3 4 On the basis of recent trends since 2000 it might seem likely that the gap has continued to close, but we don’t know for sure.

The annual survey of hourly earnings (ASHE) is based on a 1% sample of employee jobs taken from Her Majesty’s Revenue and Customs pay as you earn (PAYE) records. Information on earnings and hours is obtained from employers and treated confidentially. The survey does not cover the self employed or employees not paid during the reference period. It covers hundreds of occupations, including many healthcare jobs. So how does men and women’s pay compare in healthcare?

For those health related occupations for which samples were large enough not to be classified as “unreliable” by the ONS, nursing auxiliaries and assistants show the smallest bias in pay towards men, with women’s median hourly pay being 0.1% less than men’s (£9.40 v £9.41). For nurses the pay gap widens to 1.9% (£15.97 v £16.28). Not perfect, but good news for the largest NHS staff group (fig 1⇓).

Fig 1 Gender pay gap in median hourly earnings, selected healthcare and other occupations, 2011, UK (full time employees, excluding overtime)4 5

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Female paramedics’ and health service managers’ pay also lags behind that of their male colleagues—by 4.9% and 5.8% respectively. But at 16% less than men’s pay, the gap for pharmacists is nearly treble this. Interestingly, female medical radiographers seem to earn 5.3% more than their male counterparts on average.

Perhaps the real eye opener (although perhaps not for most female doctors) is the 28.6% pay gap between men and women among medical practitioners. In 2011, male doctors’ median earnings were £33.17 per hour—£9.49 more than their female colleagues. Trends in this gap since 2000 are erratic but suggest a pay gap of around 25% on average with no real discernible decrease (fig 2⇓).

Fig 2 Gender pay gap in UK median hourly earnings, all full time employees and “medical practitioners,” 2000-11. (Data from ONS annual survey of hourly earnings. Dotted lines represent data discontinuities)

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But what explains the big gap in pay between male and female doctors? A 2009 study for the BMA suggested that some of the difference may be “legitimate” and explained by factors such as experience, type of specialty, grade, and administrative duties (although why men end up with more experience or on higher grades—and hence more pay—raises some questions).6 Nevertheless, a substantial part of the pay gap seemed to be unexplained by such factors. Doctors questioned as part of the BMA analysis suggested that female doctors were disadvantaged because of caring roles, a “hostile culture,” and geographical limitations that reduced women’s ability to change jobs (a key way to increase pay). Of course women in other occupations face these problems too. But it may be that these factors are more acute for female doctors. The BMA report noted that more research is needed to explain the apparently inexplicable and persistent gender gap in doctors’ pay and hence to point to policies to eradicate the difference. Maybe there are lessons to be learnt from some other healthcare professions—nurses, paramedics, and managers—where gender pay differences are closer to zero.