Endocrinology Is Predicted to Become a Female-Predominant Specialty

Commentary by Elaine Pelley, MD and Julianne Imperato-McGinley, MD

Endocrinology is predicted to become a female-predominant specialty over the next several decades, according to a literature review in the January issue of The Journal of Clinical Endocrinology and Metabolism. The authors reported on the substantial gender wage gap in this field, as well as implications of fewer men entering the specialty on the deficit of endocrinologists in the United States.
Female doctor

The authors conducted a PubMed search using the terms “female physician” and “physician gender” and focused on studies published between 2000 and 2015. They found that 44% of endocrinologists in clinical practice are women. However, in 2013, 72% of entering endocrinology fellows were female. In addition, 75% of endocrinology fellowship applicants in 2014 were female, owing to a steep decline in male applicants. If these trends continue, endocrinology will become a female-predominant specialty in the near future, the study authors suggested. 

“The female predominance of endocrine training programs closely reflects the gender composition of the applicant pool. The question is, "Why are fewer men applying to train in endocrinology?” said lead author Elaine Pelley, MD, Clinical Associate Professor of Endocrinology, Diabetes, and Metabolism at the University of Wisconsin School of Medicine and Public Health in Madison, WI. “The reasons are not fully known, but research has shown that men and women weigh various factors differently when choosing a specialty.”

“Women rate factors like developing long-term patient relationships and maintaining work-life balance more highly than men, whereas men rate financial factors more highly,” Dr. Pelley explained. “The former match well with a choice to pursue endocrinology, while financial considerations would lead to nearly any other specialty choice. Currently, on average, becoming an endocrinologist offers no salary advantage to practicing general internal medicine and may not be viewed as worth the additional 2 to 3 years of training.” 

Negotiating the Gender Wage Gap
The study authors also noted that full-time female endocrinologists earn $38,000-$66,000 less than male endocrinologists. In addition to this gender wage gap, the “motherhood” wage gap that has been demonstrated across occupations may be a further disadvantage to female physicians with children.

“Pay secrecy makes it very challenging for anyone to know if the salary they are being offered is fair,” Dr. Pelley said. “It needs to fall more heavily on those hiring to ensure that gender discrimination is not manifest in salary offers. While improved negotiation skills could be beneficial, improved individual negotiations are unlikely to fully overcome systematic and unconscious cultural biases that contribute to the gender wage gap that is apparent across the workforce.” 

Will the Female-Dominated Specialty Worsen the Deficit of Endocrinologists?
A decline in male physicians entering the endocrinology specialty could impact the workforce shortage in several ways, Dr. Pelley said. The current deficit of adult endocrinologists is estimated at 1,500, which is expected to increase to 2,700 by 2025 without additional recruitment efforts, the authors noted.

“Most data suggest that women work fewer hours than men and, possibly due to gender bias in patient expectations, spend more time per patient,” Dr. Pelley explained. “This equates to lower productivity per endocrinologist, at least by traditional measures. Increased burnout risk seen in female physicians could also lead to women decreasing their clinical time or retiring early. However, I am most concerned that a specialty characterized by a workforce struggling against pervasive gender bias will not be attractive to trainees of either gender, leading to difficulty filling training programs.” 

Lack of Women in Leadership Roles is “Concerning”
“The lack of women in leadership roles in medicine, particularly academic medicine, should be concerning across the board, but particularly to those in female-predominant specialties,” Dr. Pelley noted. “If the majority of those rising to leadership roles continue to be male, and there are waning numbers of male endocrinologists, we would expect fewer endocrinologists in leadership. This could lessen the voice of the endocrine community in health systems and make it more difficult to advocate for the changes needed to ensure a thriving endocrine workforce.”

Commentary

Julianne Imperato-McGinley, MD
Abby Rockefeller Mauzé Distinguished Professor of Medicine in Endocrinology
Chief of the Division of Endocrinology, Diabetes and Metabolism
Associate Dean for Translational Research and Educational Training
Director and Principal Investigator of the Clinical and Translational Science Center
Weill Cornell Medical College
New York, NY

The study by Pelley et al provides valuable perspective and insight on the state of affairs in the field of endocrinology. As Chief of the Division of Endocrinology, Diabetes and Metabolism at Weill Cornell Medicine, I have made a concerted effort to ensure pay parity and fair treatment among my physicians, regardless of gender, in my own division. As Pelley et al note, data suggest female physicians may focus on specialties that offer more opportunities for service and the promise of a better work-life balance, while male physicians may focus on specialties with greater pay. I think that is a possible characterization of why women are becoming more prominent in endocrinology, where the average salary is low compared to other disciplines. The need for endocrinologists will continue to grow as the United States feels the increasing burden of endocrine disorders, especially those related to diabetes, obesity, and the metabolic syndrome.

Regardless of gender, it is difficult to succeed in academic medicine without mentors who will advocate for you, without protected time to conduct research, and without an absolute commitment to advancing the field. I think senior leaders, especially those who are female, do have an obligation to give back by mentoring, advising, and creating access to the resources and opportunities that will ensure success for the next generation of women. Work-life balance, I think, will continue to be challenge for women in the field, especially those with children, and there may not be a “one-size-fits-all” policy solution, but rather, a need to foster a culture that is open to negotiation as those issues come up.

January 28, 2016

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