Reply to: Gender and rank salary trends among academic dermatologists.

Dear Editor,

We read the article “Gender and rank salary trends among academic dermatologists” (Sachdeva et al., 2020) with interest, and we appreciate the authors' efforts in bringing attention to gender disparities in the field of dermatology. Their finding of higher incomes for male versus female dermatologists across nearly all academic ranks is consistent with previous studies (Guss et al., 2020, Weeks and Wallace, 2007) and suggests that further investigation of gender equality in dermatology may be beneficial in identifying the source of gender salary gaps. In particular, follow-up studies may help identify the source of this disparity by independently investigating different components of dermatologists' salaries; fixed/contractual salaries, medical practice supplements, bonus/incentive pay, and uncontrolled outside earnings may contribute to the gender salary gap differently. For example, if the gap is mainly driven by incentivization, then it may be exaggerated or underappreciated depending on the parameters associated with incentives (e.g., work hours, patient load).

In our study analyzing Veterans Affairs dermatologists with full-time equivalent base salaries, male dermatologists were compensated significantly more than female dermatologists. However, this apparent salary gender disparity was largely explained by confounding factors, such as h-index and academic rank. True gender disparity was only seen regionally, specifically in the Midwest (Do and Lipner, 2020). Our findings indicate that gender-based salary gaps in dermatology are inherently heterogenous, largely dependent on the specific salary component, institution type, or region. Therefore, focused analyses on subgroups, through experimental design or statistical approach, allow for the identification of subgroups with persistent gender-based salary gaps as well as subgroups without such gaps. Identification of these groups will allow not only for redirection of efforts to the correct population but also for revisiting groups without a gender-based salary gap to identify factors driving gender equality.

In their study of academic dermatologist salaries, Sachedeva et al. (2020) reported that there was gender disparity in salary in almost all ranks. However, the median salary growth rate was higher for women versus men in many ranks, suggesting that considerable measures have been implemented to combat salary gender disparities, with some success. Therefore, we suggest a re-analysis of their dataset, examining confounding factors (e.g., h-index) to determine whether there are indeed gender-based salary gaps. Differences in incentive-based pay or outside earnings may be partially justified, but large gender gaps in contractual salaries, supplements, and bonuses despite equal qualification and workload warrant a deeper examination of payment policies. It is also important to compare various salary components in different institution types (e.g., academic, Veterans Affairs, private) to construct a clear map of gender disparity in dermatology to help improve gender-based pay gaps.

Conflicts of interest

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Funding

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Study approval

The author(s) confirm that any aspect of the work covered in this manuscript that has involved human patients has been conducted with the ethical approval of all relevant bodies.