If you’re a woman practicing medicine in a neurological specialty, chances are good that you’re not earning as much as you could be. More pointedly, you may not be earning as much as male counterparts doing the same work. In a 2015 article published in Medscape Medical News, an earnings differential of $37,000 between male and female neurologists was reported—one of the largest gaps in pay for any medical specialty. Nor is the gender gap limited to income. In 2014, an article published by the Association of American Medical Colleges noted only 11 percent of neurology department chairs at academic medical centers were women.

These and other findings were presented to the AAN Board by the Academy’s Gender Disparity Task Force, or GDTF, in a final report dated February 2017. Charged with gathering data and recommending action to be taken by the AAN, the 11-person task force convened four times in as many months to examine gender disparities as they play out in compensation, professional advancement, leadership opportunities, and work/life balance.

Does the AAN know women are making less than men?

Elaine C. Jones, MD, FAAN, the Academy Board member who chaired the Gender Disparity Task Force, suggested the Board focus on the topic after a friend relayed this experience: As a neurologist providing hospital and clinical services as part of a larger group, the friend learned during a general meeting about the next year’s contract that she was earning $20,000 less than her male colleague doing the same work with the same credentials. As Jones relates, “She reached out to me as a Board member to ask, ‘Does the AAN know about this, that women are making less than men?’” At which point, Jones and the Board opted to create an inquiry into the subject on behalf of AAN members.

“Some of us on the task force were surprised about the discrepancy, as I was when I first ran into it,” Jones says, noting that owning her own practice (Southern New England Neurology) may have shielded her somewhat. “When I started talking with women even in other professions, it was surprising how many had had this experience. It’s kind of a dirty secret.”

Task force results

At first the committee thought it looked like a legislative issue, to be corrected by making new laws. They soon switched gears, however, partly because relevant laws already exist and partly from a commitment to identify specific areas the AAN could directly impact.

As a brief recap, here are the main findings and recommendations of the Gender Disparity Task Force.

Identified causes for disparities in compensation, professional advancement, leadership opportunities, and work/life balance:

1. Lack of salary transparency, leading to female neurologists not being aware of their colleagues’ salaries and not having relevant data for negotiation.

2. Absence of negotiating and networking by women, rooted in a difference in how the genders approach both tasks.

3. Bias and, in particular, implicit bias which can color major decisions without being detected.

4. Penalty for work/life balance and family responsibility, based on the higher likelihood that women will assume caretaking roles in their personal lives.

Task force recommendations for the AAN:

1. Lead by example by reporting percentages of women involved in AAN leadership (currently 42 percent on the board and 34 percent on subcommittees), and by continuing to promote gender-friendly work practices.

2. Continue to enhance leadership education options for female AAN members, such as the Women Leading in Neurology Program that begins Fall of 2017.

3. Improve transparency by sharing neurology compensation and productivity data and developing resources that explain requirements for various career stages, while also leveraging relationships to encourage similar transparency from other medical associations and public institutions.

4. Address bias by making available survey tools that reveal implicit biases, as well as by writing articles for AAN publications on the topic.

5. Develop mentors by training men and women leaders to mentor women, by creating networking opportunities for women, and by highlighting female neurologists who have achieved leadership roles or professional success.

6. Promote different practice options to support work/life balance.

7. Offer a scholarship/research fund to support relevant scholarship on the subject.

8. Explore legislative options that have been successful elsewhere while also updating the Code of Professional Conduct to reflect the AAN’s stance on gender disparity.

9. Conduct further investigation and publish the results.

Why don’t women negotiate?

Although Dr. Jones’ solo practice keeps her to one side of many of these issues, she relates how an experience serving as interim chair of medicine for her hospital provided insights into the situation. In that 18-month role, she was frequently involved in hiring new physicians. During that time, she says, “I definitely noticed the difference in process for men and women. The women coming in for jobs were less likely to negotiate, while the men were likely to negotiate.”

Much of Jones’ sense of why that might be aligns with the findings of the report: Lacking data related to salaries makes it difficult to know what to negotiate for. But why aren’t men and women equally affected by this lack of information? Jones remembers that early in her career, pre-solo practice, her advisors cautioned her not to accept her hospital employment contract without negotiating—an idea that hadn’t even occurred to her. She gave the document to an attorney for review, then negotiated parts herself while leaving the more difficult sections for the lawyer to discuss with the hospital. Looking back, she is grateful for that experience. “Absolutely, it was difficult for me to negotiate,” she says. “It was uncomfortable. But I’m glad I had people advising me or I might not have done it.”

It’s not male vs. female—it’s something we can change

Whether men are more likely to perceive their own value, or whether women have been more acculturated to avoid perceived conflict, are among the theories that abound for the difference between the way the two genders approach these issues. Whatever the roots of the situation might be, Jones is convinced the solution lies in women becoming more willing to advocate for themselves. And yet, she’s equally certain that the responsibility for change can’t rest with women alone. “I think we as women have to take charge of it because it’s affecting us. But it shouldn’t be up to women to change the system. We don’t have to make the solution, but we have to stop accepting it. We have to raise the issue.”

At the same time, Jones cautions against framing gender disparities as male vs. female, noting that many of the underlying biases are implicit, and shared by both genders. She’s optimistic that a multi-pronged approach by the AAN as recommended by the task force will play a significant role in reducing the incidence of gender disparity and eventually eliminate it altogether. “I don’t think this is an insurmountable issue,” she says. “It’s pretty daunting on the national level, but within the neurology community, I think it’s something we can change. I’m very positive and hopeful.”

Six Tips for Negotiating Your Next Neurology Contract

It’s galling to learn that you could have asked for more income or a better schedule when you accepted your neurology position. This is universally disappointing but when it happens to women, it may be the sign of something larger. According to numerous studies and theories, women may be more prone to leaving money on the table because of acculturation to avoid conflict, or from a sense that they will be perceived as pushy if they negotiate, or even from something as basic as not knowing how to conduct a negotiation.

The following tips are useful to neurologists from either gender, but they will be especially important for women who may not have been exposed to the process before.

1. Think holistically. Compensation is the most obvious and possibly the most important piece of your negotiation. But if you have specific schedule needs, the desire to tackle particular projects, or an interest in being supported for leadership roles, you need to raise those points as well.

2. Arm yourself with data. Whether or not you decide to cite specific salary studies in a conversation with future employers, simply having the information will help with your frame of reference. If you are an AAN Junior member, you can access the Salary Calculator Tool at AAN.com/careers. Or, consider asking your mentors and others such questions as, “What are you seeing for the salary range for first-year hospitalists?” etc.

3. Create an advisory team. Speaking of mentors—who’s advising you? When it comes to professional careers, it’s helpful to have more than one person to turn to. Start now to ask a variety of people for permission to reconnect later for career advice when you need it.

4. Use an attorney. This is a relationship you need to build early in your career, so you can access professional help each time you’re faced with a contract or other employment-related legal issue. Yes, you’ll pay an hourly fee that makes your breath catch, but remember: You’ve already invested untold dollars and hours in your career. Now it’s time to protect that investment.

5. Brush up on steps for conducting a negotiation. A quick internet search will reveal multiple sources for negotiation steps, strategies, and practice dialogs. It’s a good idea to prepare yourself by bookmarking this information before you need it. Even better—run through some of the practice scenarios so you can feel more confident when it’s time to actually negotiate.

6. Motivate yourself by thinking of lifetime earnings. If a female neurologist in 2015 was earning $37,000 less than her male counterpart, and if she were to multiply that number—even without counting for inflation—by a mere 30 years in practice…you can do the math. By passing up the opportunity to negotiate in the first job, you rob your future self and your family of more than a million dollars. Let that number give you the courage you need to negotiate your next contract.

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