It’s not about money, at least not in the sense of wanting to buy things. I don’t need more stuff. But money does represent respect and worth to an organization. At first, I found it confusing to be paid less for doing the same work. Did I calculate something wrong? Was there something I didn’t know about or understand? The equation didn’t balance. The logic was off.
And so, the exploration started. First, I asked for clarification from the chief medical officer (CMO).
There are two groups of otolaryngologists employed by the same hospital, and we just found out the other group got a 10% raise, and we didn’t. You might ask why there are two groups; that is part of the problem.
No, that difference is correct. It’s because you do different work.
But wait, that’s not true! Let me show you!
And then silence … and more silence.
Let’s talk! I can show you.
Here is the data.
No, that’s wrong! You pooled data from several surgeons. I am saying that I am doing the same work as another surgeon who is getting paid more for doing the same exact work. And you’ve skewed the way the two groups are paid. And this impacts all of us.
Deafening silence.
Another reach-out to the CMO.
No response.
All of us in one group talk. What options are there? We send an email from us all outlining the issues to leadership. Clear and concise.
Still more stalling. No conversation
or dialogue.
We need guidance as to options; we reach out and interview attorneys.
Then COVID-19 hits. It’s not the right time. Focus shifts to other priorities as the world spins into chaos.
Six months later, I tried to reach out to the chief executive officer (CEO) by email.
Hey, this is the issue, and can we get a group together to discuss and try to find solutions? Is there something else going on? Our group is majority women, led by women, and the other group is all men.
A promising response: This is important!
Then silence again.
I sent a follow-up email a month later.
I hear good conversations are occurring.
Okay. Where? With whom? I’m/we’re not at the table.
An offer of a raise. A narrowing of the inequity, but not a fix. And still no discussion. Just an offer. They don’t want to listen. They don’t want to hear.
What else to do? What’s next?
A discussion with the five of us. Many concerns and issues were raised.
The idea of a legal option is too much to bear, and too stressful. We’ll alienate hospital administration. Open to majority rule.
What options do we have? If we can’t engage in conversation, how do we move forward?
Some of us are done and willing to let the issue stand; some don’t see any other option. There is injustice; there is no hospital administration relationship to risk. There is no trust, no respect, and nothing left to preserve.
An attorney is retained. A letter asking for mediation is sent.
The stated deadline for response has passed. Then a response from the in-house attorney.
There is no issue here. If you pursue things, we will turn around and sue you for filing a frivolous suit, including legal fees.
Wow. Okay. I guess a conversation is off the table. This is despite it being stated in our contract that we are allowed arbitration if we can’t reach a resolution. It remains a one-sided process.
One last reach-out to the CEO.
I want to make sure you know what’s going on.
I hear you’ve retained an attorney.
Yes. Just wanted to make sure you were in the loop.
Give me a week. Let me get a group together to talk about the situation.
Okay.
A week later, a text: Just met with the team. I greatly appreciate you. There are no changes to the offer.
Now what? We’ve had only one-sided presentations from the “father-knows-best” CMO to our medical director. No willingness to hear another perspective or actually have a conversation. No willingness to review data. No dialogue. The CEO, at best, is hands-off, deferring to the CMO.
What are the options? Walk away from the conversation and accept the inequity? Given the lack of dialogue, it would send the message that hospital administration can do or say whatever they want. There is no engagement or partnership, simply top-down dictums. And it also means accepting that I am lesser. My work is not respected the same. The institution is paid the same by the payers regardless of who is doing the work, but they choose to pay me less. Why? My outcomes are excellent. My training hasn’t changed, nor has the training of any of the other physicians.
Leave the institution? I could, but if I want to continue in my profession, I’d likely need to commute long distances or move. My husband has a job he enjoys, and uprooting the entire family is difficult. I’m not ready to retire.
I feel they’ve given me no choice. If I want to have any semblance of self-respect, I have to move forward. It feels like if they would only listen, they would see the inequity. But they clearly are locked into their own narrative. I’ve tried for more than two years to address this concern. They are looking the other way. It’s not even subjective. There is clear data that they are paying physicians with the same seniority, the exact same board certification, doing the exact same work, at the same institution, differently. Payers are blinded to who is doing the surgery and who is seeing the clinic patient, but institutions are not.
Two physicians with nearly identical practices in terms of surgeries done are paid differently by the institution, in a manner that means that every single surgery is paid differently.
The same exact surgery.
And one physician is paid more than the other for every … single … patient seen in clinic.
And the inequity only just starts there.
But these pay equity pieces are so foundational that you can’t look away. These are apples and apples we’re comparing. Straight up.
One surgeon is a white man. One is a white woman. You can guess who is paid more.
But it wouldn’t be right either way.
The inequity is not just these two surgeons, and not just the pay per unit of work, but it’s rare to have such a striking comparison to hold up. Hospital administration is not interested in doing “the right thing.” They won’t even have a conversation to try to problem-solve or compromise. My partners would all join in pursuing the fight, but most of them don’t feel they can risk it.
I have a daughter who is starting medical school in less than a year. She thinks she wants to be a surgeon. I can’t let this injustice persist. I have no other choice.
And so, the conversation continues with the attorney.
Four Years Later…
So, what happened?
One of my partners and I filed a lawsuit against our employer in March 2021 while continuing to work there. Our initial hope had been to be able to finally have a conversation, albeit a forced legal one, to reach some sort of reasonable compromise and solution. While traversing the legal journey, we found many more examples and layers to the inequity.
We were a group that was majority women, always led by a woman. The other group was all men. The two groups were set up in a competitive rather than collaborative fashion.
I knew that the standard for the organization was to pay the same $/wRVU based on board certification, reportedly not negotiable. When they decided to give a raise to the all-male otolaryngology group, they said it was because of fellowship training. Our group had fellowship training as well. There were no other examples they could share that included paying differently for fellowship training with the same board certification, within the same hospital, or even the local five-hospital group.
Throughout the process, we found that the inequity extended well beyond the $/wRVU.
One could certainly argue that there are differences in resources needed based on one’s specialty and practice, but the resource asymmetry all went in the same direction—there was a difference between the groups in annual continuing medical education monies, medical directorship pays, physician assistant support, pay for the clinic support staff, and resident support for one group and not the other.
There was a difference in opportunity—the all-male group was billed as surgeons, and we were not. While we had surgical subspecialists, we were called “general otolaryngologists,” whereas the all-male group was “Head and Neck surgeons” (sic). At one point the electronic health record referral for the all-male group was “ENT Surgery” and we were “ENT.” This was not a level playing field.
The all-male group was allowed to select surgical patients; we saw all.
One surgeon in the all-male group and I both did primarily thyroid/parathyroid surgery and also laryngology. We did the exact same types of cases, of the same complexity. The cases were within the scope of practice for both of us. He was paid 10% more for each case and for each patient seen in clinic, handled a higher volume with greater organizational support, and earned much greater take-home pay—at least for one year calculated, I made just 62% of what he did.
But isn’t it 2024? This doesn’t really happen. At least it’s not really a gender issue. There’s gotta be something else going on that you’re not saying. But if it is a gender issue, this is a one-off, right?
Not likely.
The World Economic Forum tracks the Global Gender Gap Index (GGGI). In 2023, the overall gap was 68.6%; the U.S. ranked 43rd in the world with a gap of 74.7%. There have been strides forward since 2006 when this index was created, but the rate of progress has slowed (World Economic Forum, https://www.weforum.org/publications/annual-report-2023-2024/).
We also know that gender pay disparity exists broadly in otolaryngology. According to a 2021 Laryngoscope article, “Gender-Based Pay Discrimination in Otolaryngology,” “female otolaryngologist are paid 77 cents on the dollar compared to their male colleagues. Even after accounting for age, experience, faculty rank, research productivity, and clinical revenue, significant gender pay gaps exist across all professor levels” (Laryngoscope. doi.org/10.1002/lary.29103).
It’s unlikely parity will be reached in isolation, nor in any organization or field, without specific clarity of goal and defined effort. The first step is the acknowledgment that the problem persists.
For me, it took two years of legal process, but we ultimately prevailed in a settlement in March 2023, agreeing to settle rather than extend the process to jury trial and likely appeals.
Two things legislatively had recently changed that made a positive difference for us.
- Washington state passed an updated pay equity law (EPOA) in 2018.
- The Silenced No More Act went into effect in 2022, prohibiting employers from including non-disclosure agreements (NDAs) as part of illegal discrimination, harassment, and pay violation settlements. The fact that NDAs have been used widely as a standard in such settlements has made it falsely seem like pay equity isn’t an issue.
My co-plaintiff and I left the organization and are now happily employed elsewhere.
My husband and I pulled up roots and moved to another state. I have been lucky to have landed with a supportive, collaborative, respectful, and truly amazing academic group. I find joy in rebuilding my practice in a happier, more supportive environment. I no longer count the minutes to retirement.
And I still have my self-respect.
And my daughter still wants to be a surgeon.
Dr. Peterson is an otolaryngologist/head and neck surgeon specializing in thyroid/parathyroid surgery and laryngology with Cedars Sinai ENT, based at Huntington Health in Pasadena, Calif. (Photo credit: Allen Ho, MD)