Two emergency physicians with similar training work at the same hospital. Both have twelve years of experience. Both are contracted to work 2,000 hours per year, see roughly twenty patients per shift, and supervise staff. One is a man, the other is a woman. The same work, the same training, the same conditions. Not the same salary: The woman earns about $21,000 less each year.

That is not a hypothetical. That is what a 2025 compensation dataset (published by Offcall, our physician-led transparency company) tells us is happening in emergency medicine. Despite adjusting for hours worked, years in practice, annual patient volumes, practice setting, and cost of living, women ER physicians still earn statistically significantly less than men.

For years, many did not believe it. They thought the pay gap did not apply to emergency physicians. It is shift work after all: Doctors clock in, clock out, and the bill is essentially the same for the patients they see. Arguably, there should not be room for inequity. But Offcall’s data shatters that illusion.

The data does not lie.

From thousands of physician-reported data points and controlling for all relevant confounders, we found:

• Annual pay: Women ER physicians earn $21,000 less than men on average.
• Hourly pay: Even adjusted for workload, women earn $17 less per hour.
• Career progression: The gap widens with time. Mid-career women earn $28,000 less, and late-career women earn over $40,000 less.
• Pay structures: Productivity-based models show the greatest disparities, with men earning nearly $59,000 more than women.

This is not explained by experience, hours worked, or patient volume. Women in our dataset averaged nearly the same number of years in practice, hours per year, and patients per shift as men. The gap is not about output. It is about inequity.

Why this matters

What worries us most are the implications of these numbers. Over a thirty-plus-year career, a $20,000 gap compounds into $600,000 in lost earnings, reduced retirement savings, and diminished financial security. Once factoring in how this gap compounds over time, the loss in earnings easily becomes more than $1,000,000, particularly if compensation raises are percentage-based or promotion-based. This salary disparity contributes to higher rates of burnout and attrition among women physicians, who already leave medicine over ten years earlier than their male colleagues do.

When women are underpaid, it is unfair to everyone in the system; it undermines the stability of our already fragile physician workforce. Patients ultimately pay the price.

The excuses do not hold up

Too often, physician pay inequity is brushed aside with explanations that do not pan out: Women take more leave. Men work more hours. Women prefer salaried roles. Offcall test those assumptions directly. When controlling for job type, hours worked, pay structure, and supervisory roles, the gap persisted.

The uncomfortable truth: Women are paid less because the system allows them to be. While the trend has been reported for decades, sometimes some of us need to believe it now. It is 2025 and the numbers remain unchanged.

Where do we go from here?

Transparency is a first logical step. For too long, physicians have been in the dark about what their colleagues make. That one way to start building trust and a healthier workforce is to share what has been happening for too long. This lack of pay transparency benefits institutions and employers, not doctors. By collecting and publishing anonymous, physician-reported compensation data, Offcall is helping physicians finally see the playing field.

But awareness alone is not enough. We need systemic change:

• Hospital leaders making the decisions at the health care system level must commit to pay audits and equity reviews. Regular, transparent analyses should be standard practice, with corrective action plans implemented where disparities are found.
• Professional organizations must lead. Specialty societies can establish benchmarks, advocate for parity, and hold institutions accountable.
• Physicians must use their collective voice. Data empowers us to negotiate fairly, demand change, and push for equitable structures. Part of our mission at Offcall is to help physicians band together across specialities in order to accomplish this.

A cultural shift in medicine

Ultimately, fixing the pay gap requires more than numbers. It requires a cultural shift in how we value physicians and each other. Equal work deserves equal pay, regardless of gender. Until that principle is embedded culturally in our contracts, institutions, and communities, inequity will persist.

Conclusion

We believe this dataset should be a wake-up call. The gender pay gap in emergency medicine is real, measurable, and unacceptable. If we want to keep physicians at the bedside and maintain a strong workforce for patients, we must confront it head-on. Transparency is power. And with that power comes responsibility: to demand, and finally deliver, pay equity in medicine.

Graham Walker and Resa E. Lewiss are emergency physicians. Jake Horowitz is a health care executive.