This essay, by Sonia Bennett-Selbert, DDS, won ACOMS’ 2023 Elaine A. Stuebner Scholarship award.
As a female board-certified oral and maxillofacial surgeon (OMS), I am acutely aware of the challenges and disparities women face in our profession. The 2023 Physician Compensation Report found a significant pay disparity between women OMS and their male counterparts. In the report, OMS was first among the specialties with the largest pay gaps. This revelation is both alarming and disheartening, as it highlights the persistent wage gap in our field, among other real and perceived disparities that exist between the sexes. This essay aims to explore the reasons for the wage gap disparity and propose actionable solutions to promote wage equity between the sexes in OMS.
Examining Factors Contributing to the Wage Gap
1. Gender Bias and Discrimination
One of the primary factors contributing to the wage gap is gender bias and discrimination. Implicit biases, which are unconscious and ingrained attitudes, can lead to discriminatory behavior. In medicine, these biases often manifest as gender stereotypes, where women are expected to be nurturing and empathetic, while men are seen as authoritative and competent (FitzGerald 2017). Such biases can result in the undervaluing of female surgeons' skills, leading to lower salaries and slower career progression. Perhaps surprisingly, implicit biases are something even other women can hold towards each other within our specialty.
2. Negotiation Disparities
Numerous studies have shown that women are less likely to negotiate their salaries and job offers than men (Babcock 2003). This reluctance may stem from societal expectations that discourage women from advocating for themselves or fear of being perceived as overly aggressive. As a result, female surgeons may accept lower salaries and miss out on opportunities for salary growth. Women may also be more willing to endure less desirable working conditions and compensation terms, and in the process of being amenable, unintentionally diminish the perceived value of their work. Additionally, it may be that among women and men surgeons of equal experience, men are more often given priority treatment when opportunities to negotiate for better wages and elevated professional status arise.
From my own experience, I have witnessed firsthand the priority treatment often given to men by other men. However, having had an awareness about negotiation disparities early on, I have been able to proactively self-advocate during negotiations and have often exceeded even my own earning expectations as a result. Although I am only one example, I hope that other women will feel empowered to be more assertive in their negotiations without fear of reprisal. Since I have taken this type of strategic approach for my own wage advancement, my experience has been that on average colleagues treat me with more respect and authority in my professional role, despite having to make tough decisions at times, up to and including walking away.
3. Work-Life Balance Challenges
The demands of a career in OMS can be challenging to balance with family and personal life. This became a reality for me when I became a mother during my first year of residency. At that time, I did not know of any other women who had been or had become mothers during residency despite fatherhood being a fairly common occurrence for male surgical residents. In addition to the physical and psychological weight of childbirth, women are more likely to take on caregiving responsibilities within the family, both of which can lead to career interruptions or the pursuit of part-time or flexible work arrangements (Jolly 2014). These choices, while essential for maintaining work-life balance, may contribute to a lower annual income and fewer opportunities for career advancement, as well as potentially discouraging women from a career in OMS altogether. I am extremely fortunate in my personal life to have a partner who takes on a majority of the family care-taking roles, making it possible for me to excel professionally while still enjoying family life. This example of gender role-reversal is not unique to our family, and can be extremely rewarding for both partners.
4. Underrepresentation in Leadership Positions
Women remain underrepresented in leadership positions within the OMS field. This lack of representation can lead to fewer female role models and mentors, limiting networking opportunities and access to resources that promote career advancement and higher wages. The paucity of females in leadership and mentorship positions was especially palpable to me during my residency experience. Female role models within OMS can serve a unique role as mentors to other women within the specialty, thereby encouraging higher career goal achievements of junior female surgeons.
As a woman OMS, I have experienced firsthand all of the above challenges, and I know that I am not alone.
Proposing Strategies to Narrow the Wage Gap
1. Addressing Gender Bias and Discrimination
To address the impact of gender bias and discrimination on wage disparities, medical institutions should implement comprehensive diversity and inclusion programs. These programs should involve regular implicit bias training and awareness campaigns to help identify and combat stereotypes and discriminatory behavior. Additionally, transparent salary data and standardized pay scales can help mitigate the impact of bias on salary negotiations.
2. Empowering Women to Negotiate
Encouraging female surgeons to negotiate their salaries and job offers is critical in bridging the wage gap. Mentorship and sponsorship programs, specifically designed for women in OMS, can provide guidance and support for navigating salary negotiations. Additionally, workshops and training programs focused on negotiation skills can help empower women to advocate for themselves more effectively.
3. Promoting Work-Life Balance
Creating an environment that supports work-life balance can help reduce the wage gap by enabling women to better manage their careers and personal lives. Medical institutions should consider implementing family-friendly policies, such as flexible work arrangements, parental leave, and onsite childcare facilities. These policies can help retain female talent and minimize the impact of career interruptions on income and advancement opportunities. Men also deserve work-life balance. Implementation of these programs would benefit all OMS.
4. Increasing Representation in Leadership Positions
Efforts to increase female representation in leadership positions within OMS should be prioritized. This can be achieved through targeted recruitment and development programs that identify and nurture high-potential female surgeons. Additionally, mentorship and sponsorship programs can help create a supportive network of female leaders who can advocate for one another and inspire the next generation of women in OMS.
A Complex Issue
The wage gap between male and female oral and maxillofacial surgeons is a complex issue that demands multifaceted solutions. By addressing gender bias and discrimination, empowering women to negotiate, promoting work-life balance, and increasing representation in leadership and mentorship positions, we can work towards narrowing the wage gap and creating a more equitable and inclusive profession for all.
The ideas that men and women have about each other begin long before we enter our professional lives. Residency program leaders and the culture that we take on as residents can be formative in the way they influence how both male and female surgeons relate to each other as their careers progress. I believe that it is primarily up to the resident program directors and senior surgeons in our training programs to have awareness about these issues and reflect on the culture that they are propagating.
ACOMS and the American Association of OMS can influence and promote standards about the proportion of male and female attending surgeons within residency programs and should establish and support a network of female surgeon mentors to support the next generation of women in surgery. The more that women and men in OMS see each other as equals with unique attributes and talents, the more we will all benefit from the collaborative approach that prioritizes advancing patient care as well as our own careers and family/life balance. I am committed to advocating for these improvements and encouraging my colleagues to join me in this endeavor. Together, we can ensure that the next generation of women (as well as men) in OMS can thrive and succeed, unencumbered by wage disparities.
References
Doximity releases new study on physician compensation and impact of overwork and economic pressures. Doximity. (2023, March 3). https://investors.doximity.com/news/news-details/2023/Doximity-Releases-New-Study-on-Physician-Compensation-and-Impact-of-Overwork-and-Economic-Pressures/default.aspx
FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8
Babcock, L., & Laschever, S. (2003). Women Don't Ask: Negotiation and the Gender Divide. Princeton University Press.
Jolly, S., Griffith, K. A., DeCastro, R., Stewart, A., Ubel, P., & Jagsi, R. (2014). Gender differences in time spent on parenting and domestic responsibilities by high-achieving young physician-researchers. Annals of Internal Medicine, 160(5), 344-353. https://doi.org/10.7326/M13-0974
Dr. Bennett graduated Indiana University School of Dentistry with honors and completed her OMFS residency at Highland Hospital and the University of the Pacific in the CA Bay Area. With her extensive training, she's treated hundreds of skeletofacial deformity cases, with a focus on orthognathic surgeries. Since then, she has become one of the most experienced full-arch dental implant surgeons in her region, having cared for thousands of full-arch implant patients. She continues a successful tenure at ClearChoice Implant Centers in the Midwest. She recently opened her state-of-the-art private practice in Chesterton, Indiana. Her expertise spans the full scope of oral and maxillofacial surgery, with particular interest in dental implants, orthognathic surgery, and dentoalveolar procedures, as well as emerging technology in regenerative applications for reconstruction and aesthetics.