“Comment on: “Commitment to inclusion: The importance of collaboration in gender equity work””

I read with great interest the article Commitment to inclusion: The importance of collaboration in gender equity work by Lee et al. ¹ I found the article to be very informative as it relates to recommending solutions for the issue of inequity in salaries, roles, and promotion between genders.

The article gives multiple examples of ways to broaden the support for gender equity by including male and female physicians partnering for justice and highlighting the disparities of underrepresented minority faculty; it still lacks solutions for how to narrow the pay equity gap. ² Yes, we pursue careers in medicine with belief in altruism; however, the need for money is always front and center. Due to education debt and women increasingly becoming breadwinners of their homes, we cannot ignore the fact that women want and deserve to earn more and lead more. ³

Potential solutions include institution-wide salary reporting and abolishing of the work relative value unit system. The wRVU metric was first developed in the 1980s, with the goal of quantifying the effort required to perform a particular service relative to other service^4,5 We must normalize consistent discussions about salary comparisons and regulate public reporting of salaries amongst women and men in all medical departments. Continuing the traditions of “closed door conversations” will continue to perpetuate salary and leadership inequalities. The consequences for gender pay inequity include the costs of replacing women physicians, and greater than 50% burnout rates for women. ⁶ Another consideration is abandoning and replacing the work relative value unit (rvu). This system was created with gender and racial bias; and it has not developed with the diversification of medicine. ⁷ We need a system that allows the value of physician work to be determine by factors that benefit all physicians.

The concept of concierge medicine has been present for decades and is becoming more popular. This is a type of fee-for-service system that allows the physician to set costs for multiple medical services; it has been shown to have high rates of patient satisfaction. ⁸ Concierge medicine could be one of the potential solutions to wage inequity as patients will choose the providers and pay the set rates for that physician regardless of gender.

We appreciate the breadth of information in this review article. Incorporating authors from multiple specialities certainly added to the depth of information. We applaud the authors’ efforts to continually sound the alarm on gender inequity and we encourage the authors to make the issue of pay inequity the loudest alarm of all.