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The salary gap among male and female hospitalists is moving in the right direction. In 2023, male hospitalists made $347,000 annually and female hospitalists, $289,000, a gap of 20%, according to the 2024 Medscape Hospitalist Compensation Report. That was slightly better than in 2022, when male hospitalists made $342,000 and female hospitalists, $281,000, with the gap of 22% favoring male hospitalists.

The progress in closing the salary gap is important, but those fighting for gender equality for hospitalists are quick to point out that the gender gap isn’t just about money. Even if the salary gap was reduced to zero between men and women, other issues would remain, including having transparency in salaries, improving parental leave, promoting sponsorship and mentorship equally, and offering more opportunities for women to speak at annual meetings and to publish research.

Those gaps also need to be closed, researchers and clinicians said, as the number of hospitalists climbs steadily. As of 2022, the latest Center for Medicare and Medicaid data show that about 50,277 physicians were classified as adult hospitalists, according to the Society of Hospital Medicine. The Society doesn’t have an official gender breakdown, but a report on the Society’s site in 2023 estimated that 50% of hospitalists are women.

As their ranks grow, here is what is underway to improve the gender gap, along with what needs fixing, hospitalists and researchers said.

Salaries: Transparent, Standardized

Margaret C. Fang, MD, MPH, chief of Division of Hospital Medicine and professor of medicine at the University of California San Francisco (UCSF), has 22 years of experience as a hospitalist.

“When I started, salaries were not standardized,” she told Medscape Medical News. “People who negotiated more efficiently and persistently were sometimes able to get a higher salary.”

“I was not taught I had to fight for my salary,” Fang said. “That was intensely uncomfortable. It was probably impacted by the way I was raised [as a Chinese woman] by cultural beliefs, but also my personality and gender.” 

Over time, she said, UCSF has standardized the salaries in her division, improving this situation. “It’s very upfront.” Physicians are told: “This is the salary. There’s no room for additional negotiation.” Raises are standardized based on promotions, she said, and “we work hard to get everyone advanced and promoted.” 

At her institution, salaries can increase, of course, if physicians decide to take on additional shifts. Those are equally available to all, she said, but the opportunity will appeal more to some than others, depending on family responsibilities and other tasks.

Hiring Practices

Narrowing the gender gap even more should start with recruitment and the hiring process, Fang said.

Holistic review when interviewing physicians to hire can protect against unconscious bias, Fang said. That’s defined as taking a “whole person” approach rather than focusing only on skills and experience.

“We try to understand all the different challenges individual people had in getting to where they are,” she said. “We include a panel interview with standardized questions and the panel is a mix of faculty and staff.” 

The panel is selected with an eye to including both junior and senior level people who come from different backgrounds. The panel should represent your workforce, she said.

“Having those standardized questions helps ameliorate the ‘I like people because they are like me’ issue,” Fang said, and help maintain gender balance.

Parental Leave Policies

Emphasizing maternal leave rather than parental leave can perpetuate gender inequity, according to Maya Defoe, MD, assistant professor of medicine at Feinberg School of Medicine, Northwestern University, in Chicago, a hospitalist for 10 years. In her 2022 study, Defoe found that women who pursue nonlinear career paths — such as taking time off for maternity leave — experience negative impacts on their career trajectory. Defoe and her colleagues surveyed 141 academic hospitalists about their extended leave. Women were two times as likely to take extended leave as men. Compared with men, women hospitalists who took extended leave reported adverse impacts to their personal lives and careers. The finding suggests improved paid leave policies for both parents could help, Defoe said.

“Restricting family leave to the primary caregiver forces women to assume the brunt of childbearing responsibilities from the outset, propagating the gender discrepancy in household duties,” she told Medscape Medical News. As a result, she said, women are often perceived as less committed or too busy to take on leadership roles on the job as they simultaneously take on their new parenting role.

At Northwestern, she said, recent policy changes now provide 12 weeks of paid maternity leave for women and a month for paternity leave. While she sees that as moving in the right direction, it’s still not ideal, she said.

Advancement Opportunities

Fang and others call it the “leaky pipeline” — while many women enter the field of hospital medicine, “few end up in the upper echelons of responsibility or leadership.” She cited a personal story as a potential explanation.

“When I was applying for division chief,” Fang said, “I was extremely hesitant. They call it imposter syndrome or doubting your own abilities. It took quite a lot of convincing, many people saying ‘You should apply.’” She did apply and was named to the post in 2022.

Her observations: “Women feel they need to be very competent in their abilities,” whereas men often less so before applying for leadership roles.

While some researchers have found that qualified women are less likely to apply for other opportunities than similarly well-qualified men, Harvard researchers recently took another look at whether feeling competent was the whole story. They found that reducing the ambiguity surrounding the required qualifications increased the rate at which qualified women applied; the effects were mixed for men when the ambiguity was reduced. Reducing the ambiguity may increase the pool of qualified women candidates, the researchers concluded.

The Value of Mentorship

Mentoring is one avenue to advancement and promotions and a possible way to increase women in higher roles. Defoe defined mentoring as a one-on-one relationship — finding someone who can give advice, coach you through a project and help in other ways on an ongoing basis.

Effective mentorship is known to have a positive correlation with career satisfaction and professional growth, according to Nikhil Sood, MD, a hospitalist at Banner Gateway Medical Center, Gilbert, Arizona, who wrote a recent editorial about the need for more focused mentoring programs for nonacademic, mid-career hospitalists. While academic organizations have invested in mentorship programs, he contended that outside those settings, little focus on mentoring is provided.

His institution, affiliated with MD Anderson Cancer Center in Houston, is aiming to fix that.

“At our hospital, we have implemented key initiatives that effectively nurture relationships,” he said in an email interview. Banner offers one-on-one clinician coaching, group coaching, self-guided virtual development and a physician peer support program to promote professional growth, he said. Among other measures that may cultivate this mentorship culture, he said, is to develop clear guidelines about mentorship and to offer incentives to physicians who embrace the role of mentors.

Mentorship should differ between men and women, tailoring it to the issues and barriers, Sood said. For instance, mentoring women should focus on the pay gap and the difficulties of balancing career and family responsibilities, he told Medscape Medical News.

The Value of Sponsorship

Also valuable for helping hospitalists advance is sponsorship. It’s defined as deliberately raising someone else’s profile. For instance, Fang said, if she’s asked to write a commentary or editorial for a medical journal, she might ask a colleague with experience in the topic to coauthor it with her.

Defoe offered other ways to be a sponsor, such as passing on information to a junior colleague about a research study they might want to collaborate on, or offering to tell the lead researcher someone in your group would be good to be added to the team.

A UCSF study now underway actively encourages sponsorship. Fang participates.

“I have to fill out a form — how many faculty did you nominate for an award, honor, committee work? — every month.” The study goal is to understand patterns of sponsorship and their effects.

Open Calls for Meeting Speakers

Professional meetings that have “open calls” for speakers can help be sure that the proportion of male to female speakers is balanced, according to researchers who have studied the topic. In a study of the Society of Hospital Medicine’s open call peer review process for speakers at its annual meeting, researchers found an increase in all speakers from 35% women in 2015 to 47% women in 2019. Evaluation scores also increased during the study period.

Information about the Society’s open calls is posted on the site, with the call for content for the 2026 meeting scheduled to open this spring, according to a society spokesperson.

‘It’s the Little Things’

Beyond formal programs and policies, following “best practices” on a day-to-day basis can help reduce the gender gap, Fang said. For instance, at department meetings, they rotate the role of note taker and moderator, avoiding the stereotypical woman-as-secretary and man-as-leader roles.

Everyone is introduced as doctor, reducing the tendency found by many researchers and physicians to call women by their first names and men as doctor. In a recent study, Mayo Clinic researchers evaluated nearly 30,000 electronic messages from nearly 15,000 patients to more than 1000 physicians, finding women physicians had twice the odds as men to be called by their first names.

Not having meetings on off hours would help, Defoe said, as those hours are often when parents need to pick up children.

While these policies and procedures might seem small or insignificant, Fang said it all helps. “It’s the little things.”