MSexism 4: The gender pay gap

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The gender pay gap is alive and thriving in neurology.
That’s not only bad for women MS experts, but for all of us with the disease.

One of my best moments of 2018 came at the end of a Thursday afternoon at the ECTRIMS October conference when dozens of women MS clinicians and scientists crowded into a room – and launched the International Women in Multiple Sclerosis group. Their aim is to raise awareness of discrimination in the MS scientific community and work with all stakeholders to end it.

Their call to action is both positive and timely. For years, studies show that women experts in MS have been underpaid, under-promoted, under published and under-represented compared to their male counterparts.

Let’s look at pay. According to the American Academy of Neurology (AAN), neurology has one of the widest gender wage gaps across all medical specialities. In 2017 full-time male neurologists in the US earned an average of $264,000 per year while women earned $212,000 – or 25% less.

In the UK, no comparable statistics exist. However, evidence from the Office for National Statistics in 2016 shows the average wage gap between full-time male and female doctors stood at 34% – a significant increase from 2006 when it was at 24%.

And before some start muttering this wage differential is a result of differences in age, status or ‘lifestyle choices’ (ie – code for being pregnant, having a child, reducing work to care for children or other family members), research shows female physicians still earn less.

That said, why should this wage discrimination among neurologists bother me – a person with MS? After all, why should I care if a female MS expert takes home less money than her male colleague? Isn’t the size of her pay packet between her and her employer?

No. Because for one thing, it’s unethical. Take a look at these Norwegian children after being confronted with the gender pay gap for the first time. Because it’s illegal and because it jeopardises the care and treatment of pwMS.

By paying female neurologists and neuroscientists less than their male colleagues we are sending them a very clear message they are worth less. Add this to a stressful job – the dropout rate in neurology is one of the highest among medical specialities – and is it any wonder that women neurologists vs their male counterparts report greater burnout, depression and lower work-life balance?

As a result, some end up leaving the field – a situation we can not afford. As most people reading this know, there is a shortage of neurologists in many high-incomehigh income countries. In the UK, it is particularly acute with an estimated one specialist per 83,000 people vs one per 15,000 in Europe.

For those of us with MS, this is bad news. Neurologists are central to providing us with high quality care. For one thing, fewer specialists mean greater delays in diagnosing MS – which can have long-term, permanent impact on quality of life and disability. Consider this: a neurologist’s involvement can lead to a change in diagnosis in up to 79% of patients. (Ali, E., Chaila, E., Hutchinson, M. and Tubridy, N. (2010), The hidden work of a hospital neurologist: 1000 consults later. European Journal of Neurology, 17: e28ñe32. doi: 10.1111/j.148-1331.2009.02901.x)

It is also worth noting that in the UK, six hospitals have no acute neurology service at all and 20% of the 189 hospitals surveyed had access to a neurologist on 3 days or fewer per week.

Then there is treatment. PwMS seeing a neurologist are more likely to use disease-modifying therapies (DMTs), participate in rehabilitation clinics and see specialists, such as urologists, vs those relying on general practitioners. They also play a critical role in guiding us through various treatment options – which have become more numerous and complicated in recent years.

So what should be done? In an article in The Lancet Neurology “How do we fix the shortage of neurologists?” the writer Adrian Burton reports on some options being tried. These include fixing neurology’s image problem, finding out ways to attract more to the field and, in the UK, improving the organisation of its care systems.

All good ideas – but I believe Burton misses a glaring point or what Professor Gavin Giovannoni calls “the elephant in the room.” Why no mention of women neurologists, their high burn-out rate and what can be done to remedy this? Losing these highly educated and highly trained individuals is not only wasteful on a personal level, but it harmful to those in the MS community. We need to focus on supporting them so they reach their full professional potential. And that starts with pay.

Spoiler alert: this issue is not going to go away.  Women are going to continue becoming doctors – and in increasing numbers. People are going to continue to need neurologists – and in greater numbers as the population ages. It is up to all healthcare leaders to end this persistent gender pay gap now.

MS waits for no one.

By Rachel Horne


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Rachel Horne

4 comments

  • So frustrating to read…

    Some good news for women scientists and hopefully MS
    — Professor Katerina Akassoglou to receive 2018 Prize for work understanding the origins of nerve damage in MS and identifying potential therapies to stop it
    Katerina Akassoglou, Ph.D., a leading researcher at the Gladstone Institutes and the Department of Neurology at the University of California, San Francisco, is the winner of the 2018 Barancik Prize for Innovation in MS Research.
    https://www.nationalmssociety.org/About-the-Society/News/University-of-California-Scientist-Wins-Barancik-P?fbclid=IwAR3WyoSmj17UGZDo1oozxFvYfvvF2deRbPvCmDedITYOAAE-6Qx9xZ4KyMc

    • Absolutely fantastic news!
      By coincidence, Mr and Mrs Barancik spend their winters in Sarasota, Florida where I am at the moment. They have agreed to do an interview with me – which I intend to post on this blog. I would like it to be quite informal and chatty – and also to thank them for setting up the prize.
      Question – I am not an MS expert as you well know – but is it fair to say the Barancik prize is a big deal in the MS scientific community?
      Also if anyone has any questions they want me to ask – pls let me know.

  • An astoundingly good post Rachael providing excellent validation of the need to address the difficulties in recruiting and maintaining women neurologists.

    Also a disheartening read when the need for specialists in neurology can only increase as ever more are diagnosed with MS and other neurological conditions.

    I’ve often thought, as a PwMS, that there must be a struggle to determining the ‘positive strokes’ in being a neurologist, as you constantly deal with those who are deteriorating, and there’s no psychological boost of ‘fix them up and send them on their way’ Add to this issues such as a gender pay gap and it’s difficult to comprehend how women in post are going to be maintained and others attracted to the professional role and remit.

    Right now I feel even more appreciation of having had the same neurologist for the past two and half years and that my neurologist is a woman.

    • Very interesting point – and something that popped up in the research I did. I think you are exactly right that as a neurologist the emotional toll of dealing with patients who never get better and never leave your care – must be very tough. I think that explains why some young doctors go into dermatology and radiology – according to the Lancet article I mentioned. Plus I think in the US – the pay is better as well.

By Rachel Horne

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