The physician gender pay gap is often discussed as a difference in annual earnings. But that single number can hide something more consequential: how compensation differences develop and accumulate over the course of a career.
Doximity's 2026 Physician Compensation Report found that the gender pay gap remained at 26% in 2025, unchanged from 2024. After adjusting for factors including specialty, geography, years in practice, and hours worked, average compensation was still $122,276 higher for men than for women. Men also reported higher compensation in every specialty Doximity examined.
It is tempting to reduce that difference to one number: salary. But physician compensation is increasingly built from several moving parts at once, and the gap can widen—or begin—long before a physician compares two base-salary offers.
The more useful question is not simply why women physicians earn less. It is where the difference enters the compensation equation in the first place, and how those differences can accumulate over the course of a career.
Base Salary Matters, but It Is Only One Piece
Physician compensation has become increasingly blended. AMA data from 2024 show that 60.8% of physicians received compensation from more than one method. Salary was still the largest component on average, accounting for 58.2% of physician compensation, while productivity contributed 28.1%. Bonuses and practice financial performance also played a role. That matters because two physicians with similar base salaries can end the year with very different total compensation.
Productivity thresholds, RVUs, bonus formulas, quality incentives, call pay, leadership stipends, partnership distributions, and other variable components can all affect what a job is ultimately worth. A contract that looks equitable at the base-salary level may produce a different outcome once those other elements begin to compound.
The AMA's 2024 compensation analysis found a gender difference in how those components were distributed. Women physicians received a larger average share of their compensation from salary, while men received a larger share from productivity-based compensation. The AMA noted that a larger variable productivity component could create more potential upside. That doesn't prove that productivity-based models themselves cause the physician gender pay gap. It does show why comparing base salary alone may miss part of the picture.
The Starting Number Can Follow You for Years
One of the most important compensation decisions in a physician's career may happen before the first day of work. Research in academic medicine found that women had lower starting salaries than men in 42 of 45 subspecialties examined. Women also had lower estimated 10-year earning potential in 43 of the 45 subspecialties. The researchers estimated that equalizing starting salaries would eliminate a substantial portion of the early-career earning difference.
That finding illustrates why a relatively modest initial gap can matter so much. Future raises may be calculated from an existing salary. Bonuses may be tied to thresholds built into the original contract. A physician changing jobs may also use current compensation as an anchor when evaluating the next offer. Even when subsequent increases are similar, two careers that begin at different starting points can remain financially separated for years.
This is one reason the gender pay gap is not simply an annual problem. Doximity cites prior analysis estimating that male physicians can earn more than $2 million more than female physicians over a 40-year career. The difference is not necessarily created by one dramatic compensation decision. It can be built through a series of smaller ones.
Productivity Pay Doesn't Capture Every Kind of Work
Productivity-based compensation can sound straightforward: see more patients, perform more procedures, generate more RVUs, earn more. In practice, productivity is influenced by factors physicians do not always control equally.
Specialty matters. Practice setting matters. Patient mix matters. Referral patterns matter. Access to operating rooms, procedures, desirable shifts, staffing support, and other resources can influence how much billable work a physician is able to perform.
There is also evidence that the way physician work is valued may contribute to compensation differences. A 2025 JAMA Network Open study examining physician payments in Ontario, Canada, noted that women physicians, on average, have been found in prior research to spend more time with patients, care for more medically and socially complex patients, and provide more guideline-based care. The authors questioned whether payment models that emphasize volume fully capture the value of that work.
That does not mean every female physician practices one way and every male physician another. But it does raise an important question: What does a compensation model reward, and what valuable work falls outside that formula?
If longer visits, counseling, care coordination, mentoring, administrative work, or complex patient management are not reflected adequately in productivity measures, physicians doing more of that work may generate less compensation even when their contribution to patient care is substantial.
Promotion and Leadership Affect Compensation Too
Salary and productivity are only part of a physician's financial trajectory. Career advancement matters as well. Much of the research on gender differences in physician promotion comes from academic medicine, where advancement is particularly easy to track. But the underlying connection between career progression and compensation extends beyond academic institutions: leadership roles, greater responsibility, partnership opportunities, and other forms of advancement can all influence what a physician earns over time.
A systematic review and meta-analysis published in 2024 found that women were less likely than men to be promoted to full professor in academic medicine, even after adjustment in many of the included studies. The authors identified differences in productivity, leadership opportunities, and gender bias among the factors associated with the disparity.
Earlier research also found that women physicians were less likely to reach senior academic ranks after accounting for factors such as years since residency, publication history, research funding, and clinical-trial involvement. Why does that belong in a discussion about pay?
Because promotion frequently changes more than title. It can affect salary bands, leadership stipends, administrative opportunities, speaking invitations, industry relationships, consulting work, and access to other paid professional roles.
In one academic-medicine analysis, a one-year delay in promotion from assistant to associate professor reduced estimated 10-year earning potential by a median of about $26,000. Failure to receive the promotion during that period had a much larger estimated effect. Career opportunity and compensation are difficult to separate.
The Pay Gap Extends Beyond the Employer Paycheck
Physician income does not always come entirely from the organization where someone practices. Consulting, speaking, advisory work, research relationships, and industry payments can create additional income and career visibility. Those opportunities are not necessarily distributed evenly either.
A JAMA Surgery study examining payments from major medical-industry companies found that men received substantially higher payments than women among the highest-compensated physicians in its dataset, even after accounting for academic rank, research impact, and specialty.
More recent research examining U.S. obstetrician-gynecologists found gender disparities in industry payments even though women represented the majority of payment recipients. Women received lower cash payments per transaction and represented only 28% of the top 100 earners in the study.
Those payments are not the primary source of income for most physicians. But they illustrate a broader point: the gender gap can appear in who gets access to financially valuable opportunities beyond ordinary clinical compensation. And those opportunities can create more than immediate income. They can lead to visibility, networking, research collaborations, leadership roles, and future career opportunities.
What About Work-Life Balance?
This is where the conversation becomes more complicated. Doximity found that 86% of women physicians, compared with 71% of men, said they had accepted or would accept lower compensation in exchange for greater autonomy or work-life balance.
At first glance, it can be tempting to interpret that as a simple choice: women value flexibility more, so they earn less. That explanation is incomplete.
A physician may choose fewer clinical hours, a more predictable schedule, or a position with less call because those tradeoffs genuinely make life better. There is nothing inherently problematic about choosing time or autonomy over maximum compensation.
The harder question is why the tradeoff is necessary, who is most likely to need it, and whether the workplace is structured so that flexibility carries a disproportionate financial penalty.
Family responsibilities remain unevenly distributed in many households, and physician careers are not immune to that reality. Research on women in academic medicine has repeatedly identified family responsibilities and work-life balance as factors associated with differences in promotion and retention.
So the useful question is not whether women physicians are “choosing” lower pay. It is whether physicians have equal access to career structures that allow them to pursue both compensation and the life they want.
Negotiation Matters, but It Isn't the Whole Answer
Compensation discussions often end with the same advice: negotiate. Physicians absolutely should understand market compensation, ask how productivity is calculated, review bonus thresholds, and know what parts of an offer are negotiable. The AMA itself advises physicians evaluating contracts to look beyond base pay because compensation often includes multiple line items and formulas.
But it would be a mistake to make negotiation the explanation for a gap this persistent. Doximity's adjusted numbers already account for major factors such as specialty, geography, years of experience, and hours worked, yet a large difference remains. Academic research has likewise documented pay differences after accounting for experience, specialty, faculty rank, research productivity, and other measurable characteristics.
Negotiation can help an individual physician improve an offer. It cannot, by itself, explain or solve a pattern that appears across specialties, practice settings, compensation structures, and career stages.
The Questions Physicians Should Be Asking
For an individual physician, the value of understanding the gender pay gap isn't simply knowing the national percentage. It is knowing where to look in your own compensation.
When evaluating a position, physicians should understand not only the base salary but how raises are determined, how productivity thresholds work, which activities generate RVUs, how bonuses are calculated, whether leadership and administrative responsibilities are compensated, how call is paid, and what happens to compensation when clinical time changes.
It is also worth asking how promotion works, what partnership or ownership pathways exist, how protected time is treated, and whether compensation data are reviewed internally for equity. Those questions matter for every physician, regardless of gender. But for women physicians, the persistence of the national gap makes them especially consequential.
The Gap Is Built Over a Career
The physician gender pay gap is often presented as one statistic: 26%. That number matters. But it can also obscure how compensation actually develops.
A slightly lower starting salary. Less access to productivity upside. A delayed promotion. Fewer compensated leadership opportunities. A schedule change that carries a financial penalty. A missed consulting or industry opportunity. Another job offer anchored to the compensation that came before it.
None of those alone has to create a career-defining difference. Together, over 20, 30, or 40 years, they can. That is why the most useful conversation about physician pay equity is not simply whether women and men receive the same salary for the same job. It is whether they have the same opportunity to build compensation over the course of a career.
And that is a much bigger question than salary alone.
Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.