Certainly, access to the best-paying positions in medicine and academic medicine is restricted for women. In academia, Association of American Medical Colleges (AAMC) data from 2014 demonstrate that women are poorly represented among leadership positions, occupying only 15% of department chairs and 16% of deanships. Jagsi et al documented that female cardiologists are significantly less likely to practice interventional cardiology than their male peers, and are commensurately less well compensated.3

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The quality of experience junior physicians have in early positions may, furthermore, influence success and compensation. Women in academics may be saddled with greater amounts of the less rewarding tasks. Guarino and Borden investigated the amount of academic service performed by female or male faculty.4 Using 2 large databases, they found that female faculty perform significantly more internal service than men, controlling for rank, race/ethnicity, and department.

Survey data demonstrate that research faculty who report having been the beneficiary of strong sponsorship by a faculty mentor are more likely to achieve academic success, and that such mentorship is reported more often by men than women.5 Indeed, discrepancies in the value placed on the work of women in academic medicine may begin even before graduation.

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A review of 1120 senior theses submitted to fulfill the requirements for graduation from the Yale School of Medicine documented disparity in the rates at which women received a coveted designation of “highest honors.” Women authored 51% of submitted theses, but earned only 31% of highest honors awards (odds ratio [OR], 0.41, 95% CI, 0.23-0.74). Men were more likely to work with a mentor with a history of multiple thesis honorees, take an additional year of study, secure competitive research funding, undertake a Master’s degree, and conduct laboratory research. Yet even after adjustment for these factors, women were still less likely to receive highest honors.6

Salary discrepancies are documented even within seemingly homogenous groups of physicians. In a survey of recent recipients of NIH mentored career development (ie, K08 or K23) awards, the mean salary was $141,325 for women and $172,164 for men. Male gender remained an independent, significant predictor of salary (+ $10,921, P < .001) even after adjusting for specialty, academic rank, work hours, research time, and other factors. Ten to 17% of the gender disparity was unexplained by of the variables the investigators examined.7

Unconscious or implicit bias continues to drive decisions made about hiring, compensation, promotion, access to internal resources, and the climate in which women physicians work.