The gender wage gap
The mean salary for women ObGyns remains lower than that for men at every academic rank, with the differences ranging from $54,700 at the assistant professor rank to $183,200 for the department chair position.11 Notably, the pay discrepancy persists after adjustments are made for common salary-influencing metrics, such as experience, practice construct, and academic productivity.12 The gender salary gap is further identified for women subspecialists, as women reproductive endocrinology and infertility specialists and gynecologic oncologists earn $67,000 and $120,000 less, respectively, than men colleagues.13,14
While the gender wage gap often is attributed to women’s desire to work part time, similar rates of graduating women and men medical students in 2018 ranked schedule flexibility as important, suggesting that work-life balance is related to an individual’s generation rather than gender.11
Parenting status specifically adversely affects women physicians, with an ascribed “motherhood penalty” and “fatherhood bonus” phenomenon: women physicians who became parents lost an additional 6% salary, whereas men physicians saw a salary increase of 4% with parenthood.15
Most worrisome for the specialty is evidence of declining wages for ObGyns relative to other fields. “Occupational segregation”16 refers to the pronounced negative effect on earnings as more women enter a given field, which has been described in other professions.17 Overall, ObGyn salaries are the lowest among surgical specialties18 and show evidence of decline corresponding to the increasing numbers of women in the field.16
Interpersonal interactions and sexual harassment
In the workplace, women in ObGyn face more interpersonal relationship friction than men. Practicing women ObGyns report differing treatment by nurses as compared to men,19 noting that additional time and effort are required to nurture professional relationships. Additionally, nurses and trainees20 evaluate practicing women ObGyns more harshly than they evaluate men. Further, women gynecologic surgeons experience gender bias from patients, as patients endorse a preference to have a woman gynecologist but prefer a man gynecologic surgeon.21
In addition to gender bias, the experience of gender harassment, including sexual harassment, is common, as two-thirds of women gynecologists report workplace harassment, 90% of which is attributed to gender.22 This rate is 3 times higher than that for men, with a senior colleague in a position of power within the same organization reported to be the harasser to women in 91% of occurrences.
Advancement and promotion
Within academia, women faculty face specific career-limiting barriers related to gender. Rates of academic promotion and leadership opportunities remain lower for women than for men faculty. Although there has been more women representation in ObGyn over the past 20 years, the number of women serving as department chairs, cancer center directors, editors-in-chief, or on a board of directors remains lower than what would be expected by representation ratios.23 (Representation ratios were calculated as the proportion of ObGyn department-based leadership roles held by women in 2019 divided by the proportion of women ObGyn residents in 1990; representation ratios <1.0 indicate underrepresentation of women). This lag in attainment of leadership roles is compounded by the difficulties women faculty experience in finding mentorship and sponsorship,24 which are known benefits to career advancement.
Having fewer women hold leadership roles also negatively influences those in training. For example, a survey of emergency medicine and ObGyn residents identified an implicit gender bias that men and women residents favored men for leadership roles.25 This difference, however, was not significant when division chiefs and department chairs were women, which suggests that visibility of women leaders positively influences the stereotype perception of men and women trainees.4
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