We are all responsible for women physicians’ pay discrepancy [PODCAST]

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“Take the time to invest in yourself; it is the best investment you can make. Work to improve your communication, negotiation skills, and financial literacy skills. Think twice before accepting the first offer at face value; you owe it to yourself.

Have a contract lawyer review your contract. A number of factors go into a contract, more so than salary. Consider vacation time, CME time, the amount of call, noncompetes, partnership eligibility, and benefits.

Both parties: Have the discussion. Why is this? What can be done about it? Openly discuss and don’t shy away from difficult conversations.

Be the change maker.”

Sharon McLaughlin is a surgeon.

She shares her story and discusses her KevinMD article, “We are all responsible for women physicians’ pay discrepancy.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Sharon McLaughlin. She is a surgeon, and her KevinMD article, which we’ll talk about today, is titled “We are all responsible for women physicians’ pay discrepancy.” Sharon, welcome to the show.

Sharon McLaughlin: Kevin, thank you so much for being here. Thank you for being a voice for physicians and all that you do.

Kevin Pho: We’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.

Sharon McLaughlin: It’s a long one. Plastic surgery, doing pretty good, ended up being married, having a child, trying to run the staff, and ended up totally burnt out. So many of us think of burnout when we’re working for others, like in a corporate job, but you can also get burned out in private practice. A lot of that has to do with boundaries and being able to say no. Looking back, I wish I had done things differently. I wish I had better systems and processes in place.

I took a job in utilization management. I’m very much an advocate for women physicians and having multiple streams of income. I started a group, Female Physician Entrepreneurs. We just launched a business program, and I am thrilled to be here and just being able to help others. When people say, “Do you miss clinical?” I don’t really miss the clinical, but I do miss interacting, and I feel like this fills the void, being able to help others.

Kevin Pho: So a lot of people say private practice is an escape from hospital-based or corporate-based settings, and you got burnt out from that. So tell me, what are some of the things that you would have done differently in your private practice setting?

Sharon McLaughlin: OK, I worked too much in my business. I didn’t work on my business. I would have stepped back and really learned what it takes to run the back office. I was so busy doing emergency room call, running around, taking patients, patient care, managing the staff, that I truly never learned the backbones of running the back office of a medical practice. I’m sure there was practice management when I started, but I didn’t look into that. I just jumped right into the practice and expected to figure it out as I went, and that wasn’t the case.

I remember being surrounded by men physicians whose wives were in their office. I would talk, like if we would hang out or whatever, and they’d be like, “Oh, you don’t know that?” I said, “No, I don’t.” And it occurred to me that’s probably a really great setup. The doctor needs to doctor, and there needs to be a strong office manager or somebody that can really run the practice for you.

That being said, I’m a strong believer that you should know the ins and outs. You don’t have to do it, but you’re better off learning it at the beginning, spending time with others, if it means paying for a mentor, just going to other offices and learning how to run it. Speak to the billers, speak to the people that are doing the revenue cycle, speak to the schedulers. Really get to know the backbones of an office. And nowadays, I think with different Facebook groups, it’s much easier to learn how to run a practice than when I started. Like I said, we really just jumped in and did it.

Kevin Pho: All right, so let’s talk more about your KevinMD article, titled “We are all responsible for women physicians’ pay discrepancy.” Now, for those of you who get a chance to read your article, just walk my audience through it. Share the story of why you decided to write it.

Sharon McLaughlin: Yeah, we know that there’s discrepancy in pay with women physicians, so why is that? Now, if you look, there’s one article that I remember seeing: From the time that women physicians enter the workforce, right from residency, there’s a discrepancy in pay and what is offered. And that was in several, not all, of the fields, but I think it was like 90-plus percent of them. So you have to wonder, why is that, right? So I think that there should be better transparency in pay.

I also think that we know that women physicians, their time is less flexible, in the sense that they get called more often. Patients reach out more to women physicians, so therefore those calls have got to be documented. You spend more time in the electronic medical record, which is time-consuming, and that’s a problem. And the other thing is, there’s a higher rate of depression and suicide among women physicians.

So part of this, I believe, is up to the employer, as far as pay transparency, being fair to men and women. Like, why would that study show that there’s a discrepancy in pay rate from residency, when we’re all talking about that discrepancy?

Kevin Pho: So just to give my audience a sense of the scope, how much of a discrepancy is there?

Sharon McLaughlin: It could be anywhere from, like, 20 percent, and we could pull it, but the problem is, even if it’s 5 percent, over years that’s compounded. If you think about the interest over a year, it could be 5 percent, but then as your raises go up, and if you had invested that money before, there could be like a million dollars over the course of a career. And that I find hard.

I have this discussion a lot with my husband. We don’t see eye to eye on that. He feels like women are, we both feel like women are the primary caretakers of children, not in all cases, but in a lot of cases. So then they ask for more flexible schedules. They’re not working as much. But it’s more than that. If you do pay, like, per hour, there is a difference, and that’s why I’m concerned.

So I believe that the employers need to be more transparent and be more fair, but I also think it’s up to women physicians as well. We know that women physicians, and women in general, don’t negotiate as much. Why don’t they negotiate? Why don’t they advocate for themselves? Again, you’re leaving money on the table by not asking. If you don’t ask, the answer is going to be no. She never asked. So if you go ahead and start advocating for yourself and asking for raises, again, it may not be that much, but over the course of time, that can really add up. It’s about working smarter and not harder.

And then being asked, sometimes people feel like perhaps they’re going to burn out. Ask for a half a day of doing something. Again, you could say to yourself, “I don’t want to ask. The answer is going to be no.” You don’t know until you put it out there. So I believe it’s up to the individual to ask.

The other thing is, you need knowledge, right? If you don’t know what the fair market price is, then how could you negotiate? Where would you even start? Where would you end? Where is a good price for me or not? So it’s up to you to do your homework. There are companies out there that will do it for you, or there are groups out there that help you come up with an average, and then you can work from there. But you really should go into negotiations knowing where you stand. And if you can’t get the salary that you want, there are other things too: CME hours, the amount of vacation that you’re going to take, having that flexible schedule, a day or half day or whatever it’s going to be. So it is salary, but if you can’t get the salary, there are other things that you can ask for as well.

Kevin Pho: Now, let’s talk about a couple of things that you said. So number one, you said employers have to be more transparent. What exactly do you mean by that?

Sharon McLaughlin: Would it be OK for people to mention right from the beginning what the pay is? And why isn’t it? I can see, over the course of time, why they want to do that, because people excel differently. There’s some argument that they should do that as well. But right from the beginning, it should be transparent what salaries between a man and a female, or however you want to break this down, are. And I don’t really have, from that point, I’d have to say that it is up to the employer to be transparent.

Kevin Pho: And you work with a lot of women physicians, and you said that, in general, women physicians may not be as strong negotiators as men. Now, what are some of the reasons that they tell you? What are some of the things that you hear that they could improve on when it comes to negotiating? What are some things that you hear when you talk to other women physicians?

Sharon McLaughlin: So we know that there’s a lack of self-esteem, right? Low confidence. We know that when applying for a job, a man can be 60 percent qualified and the woman 60 percent qualified, and who’s going to apply for the job? Studies have shown that the men will apply. The women feel inadequate: “I’m not good enough. I’m only 60 percent there.” They could even be 80 percent there, and they still wanted to apply for the job.

So some of that falls on them. But low self-esteem, and some of it is the people-pleasing. We don’t want anyone to be upset if we ask for something. We’re asking for something, so we don’t want to do that. We people-please. We try to do whatever we can to make the other person happy. Those are the two things that come up most commonly.

Kevin Pho: Now, if you’re a woman physician at a negotiating table, or when you want to talk to medical administrators about your job, about the contract, what are some high-yield things that they could do during those negotiations that you recommend?

Sharon McLaughlin: Knowing your homework ahead of time, doing your homework ahead of time, knowing exactly where you stand before you get there. Really, I think so many of us take for granted what we’re able to offer. Really itemize: What are you able to offer? And it’s more than just seeing patients. Perhaps there’s a committee you can get involved in. Perhaps there’s some background that you can offer as well. So, doing your homework ahead of time, knowing exactly where you stand, and being able to negotiate and really speak up for yourself.

And I’m a big firm believer in having options. So don’t let that be the only job that you’re going for. Know that you have options. I know this is on the side, but I believe that if we have options, we’re better negotiators, because we have less to lose. So say, for instance, you were investing money and you had wealth. You wouldn’t feel so quick to take the first job that came along, because you have wealth, and you know that you can walk away from this one. I think sometimes we feel like we’re pushed into positions where we need to take the first thing that comes along, and that’s not necessarily true. So make sure that you’re getting financial literacy as well, spending time doing self-development and working on you as a person. If you are able to build up financial wealth, you’ll be less likely to take the first thing that comes.

Kevin Pho: So as you were sharing your story, one of the things that you mentioned was that it was important for women physicians to have multiple streams of income. Talk more about that.

Sharon McLaughlin: There are so many things that we can do. For one, like with the business program, we’re starting off with basically where you are right now. So what can you do? In general, I think physicians are pretty good speakers, and if you really put your mind to it and worked on the speaking skills, you would improve. So why not speak about something and get paid for it?

The other thing that you can do is have a program, in addition to being paid for a patient, something that you’re really passionate about. Perhaps it’s, like in my case, negotiation, right? I’m an advocate for negotiation. Do a framework that you call your own. Mine will be MACK, short for my name, but also my dad’s name, so it has a lot of meaning to me. M for mindset, A for asking, C for just getting out there, having that conversation, being able to ask, and having strong communication, and then K for knowledge. You need to know the knowledge.

So there are many things that you can do. Kevin, you yourself, look at all that you’ve done with KevinMD. It’s amazing. We followed you, and you had your own program. Now you’ve joined, and the same thing, you’ve done speaking, you’ve done podcasts, you have associations, partnerships, ambassador programs, and affiliate programs. There’s a lot that people can do. It’s not just all seeing patients. That’s where you’ll make the impact, because that’s what you wanted to do as far as getting into medical school and helping people. But there are other ways to partner with other programs and have your own program as well. Books, we mentioned; you can do that. It’s hard to sell a book.

A lot of this, nothing happens overnight. There truly is no passive income, as far as I’m concerned. Real estate is probably the easiest, but it still takes money to get there. You need money to invest, and therefore it’s not truly passive, because you have to get that money first. There are many different groups out there that can help as far as different things that you can do. Look around. Surround yourself with those people that are doing different things. But real estate is something I most commonly see. Having different courses, whether it’s wellness or dieting, that’s always a big thing, although not as much anymore. People, I think, are tired of diets. But wellness programs, where physicians do a wellness program. Do something that you’re passionate about, and it could be something totally outside of medicine as well.

Kevin Pho: Now, in our world, where physicians are more than their degrees, where physicians are doing things other than seeing patients in the exam room or doing procedures in a hospital, you’re already preaching to the converted. But I talk to other physicians, the majority of whom are saying, “I’m too busy. Doctors should be seeing patients.” And there’s almost a little bit of condescension when they see other physicians with side gigs. So talk to that majority. Why is it important for them to diversify income streams? Why is it important for them to find a passion sometimes outside of clinical medicine?

Sharon McLaughlin: It may not be for them. You have to have a want and a need. And if you feel fulfilled doing what you’re doing, without the need, you don’t feel like you’re stuck. Why do people change? There’s usually an indication of why they change. They feel unfulfilled. They feel stuck in a corner. They feel like they’re heading to burnout. They’re not exactly happy. There are quite a number of physicians that are truly happy, 100 percent, exactly where they are, whether it’s an employed position or they’re in private practice. They don’t need anything else. They feel fulfilled, and that’s perfect for them. They’re enough, right exactly where they are.

But if you feel yourself questioning, “Why am I doing this? This isn’t what I expected,” then I invite you to step back and say to yourself, think and ponder, why are you asking those questions? It’s usually an indication that you’re not fulfilled, that you want to make an impact in some other way, shape, or form. I don’t know what that is, but that’s why you surround yourself with other people.

Kevin Pho: We’re talking to Sharon McLaughlin. She’s a surgeon, and her KevinMD article, which we’re talking about today, is “We are all responsible for women physicians’ pay discrepancy.” Sharon, what are some of your take-home messages that you want to leave with the KevinMD audience?

Sharon McLaughlin: Always speak up for yourself. If you don’t speak up for yourself, nobody else will. You’re the one that gets to set boundaries. Nobody else gets to do that. It’s up to you to speak up for yourself.

Kevin Pho: Sharon, thank you so much for sharing your story, time, and insight. Thanks again for being on the show.

Sharon McLaughlin: Thank you so much, Kevin.

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