Improved Infectious Diseases Physician Compensation but Continued Disparities for Women and Underrepresented Minorities

To the Editor—We appreciated seeing a recent report on physician compensation in Open Forum Infectious Diseases. Trotman et al [1] found, in the largest survey of infectious diseases (ID) physician compensation to date, that ID physicians are generally paid more than the amounts previously published in Medscape and Doximity reports [2, 3]. The authors made initial efforts to examine differences in physicians’ salary by gender and noted that further analyses of the gender disparity in physician salaries are underway in conjunction with the Gender Disparity Task Force established by the Infectious Diseases Society of America (IDSA) in September 2016 [4]. Evaluating compensation disparities by race/ethnicity is equally important and complementary to evaluating disparities by gender. Although African Americans and Hispanics account for 13% and 18% of the US population [5], respectively, they account for only 7% and 12% of ID trainees [4] and only 4% and 8% of IDSA member physicians [1]. Moreover, underrepresented minority (URM) physicians earn less than white physicians [6] but are more likely to care for URM patients [7], who are, in turn, disproportionately affected by infectious diseases [8]. Unfortunately, the Medscape, Doximity, nor IDSA publications on compensation have not included comparisons by race or ethnicity. Some data on physician compensation by race are presented in the full ID compensation report available to IDSA members online (www.idsociety.org/clinical-practice/compensation/compensation/), in the “Clinical Practice: Compensation” section [9]. According to these data, African American ID physicians were paid 7%–13% less than almost all other racial/ethnic groups as private practice owners, hospital employees, academic medical center employees, and research/teaching physicians (Table 1). Median Compensation for Full-Time Infectious Disease Physicians by Race/Ethnicitya Abbreviations: AMC, academic medical center aData taken from the full infectious diseases compensation report available to Infectious Diseases Society of America members online (www.idsociety.org/clinical-practice/compensation/compensation/), in the “Clinical Practice: Compensation” section [9]. Numbers represent the number of full-time physician respondents answering each question. bIncome results in groups with <10 respondents were suppressed to maintain confidentiality. Median Compensation for Full-Time Infectious Disease Physicians by Race/Ethnicitya Abbreviations: AMC, academic medical center aData taken from the full infectious diseases compensation report available to Infectious Diseases Society of America members online (www.idsociety.org/clinical-practice/compensation/compensation/), in the “Clinical Practice: Compensation” section [9]. Numbers represent the number of full-time physician respondents answering each question. bIncome results in groups with <10 respondents were suppressed to maintain confidentiality. Although these data are based on unadjusted salaries with few responders in the URM categories for each practice type, they illustrate several points. First, given that disparities in pay do seem to exist in this small sample, a more robust attempt to gather income data on URM members, adjusting for other potential confounders, is warranted. Second, it will be important to identify reasons for these compensation disparities, support URM ID fellows and junior faculty through leadership development, and develop strategies to create more equitable compensation. Finally, although the survey collected binary information about gender, it did not collect information about gender identity and sexual orientation; further work should be done to define and report on these factors. We are heartened to see increasing awareness of the inequities in physician compensation and career advancement. In their 2017 report, Aberg et al [4] urged IDSA “to establish a diversity and inclusion committee to generate the data necessary for developing a strategic plan to improve the diversity of our workforce and eliminate disparities”. In September 2018, IDSA appointed members to the new Inclusion, Diversity, Access & Equity (IDA&E) Task Force, and the group has already released a set of guiding principles whereby IDSA commits to reflect the diversity of its membership [10]. Future tasks should include the creation of a road map for the IDA&E Task Force that includes definitions, metrics, and actionable plans to address gender and racial/ethnic disparities in ID and ensure that the full potential of women and URM ID physicians is realized. Meanwhile, individual ID physicians can themselves be more intentional about reaching out to mentor, sponsor, and support women and URM to join and remain in the field of ID. In conclusion, we are encouraged by the ID physician compensation data published by Trotman et al [4] and look forward to additional analyses focused on gender and racial/ethnic income disparities. Creation of the Gender Disparity and IDA&E task forces with their commitment to examining disparities are positive steps toward ensuring equity for all IDSA members. We look forward to seeing the work of these 2 groups and are optimistic about the future of women and URM physicians in ID. Author contributions. J. R. M. wrote the first draft and subsequent revisions; S. H. B. and N.F. contributed significantly to subsequent revisions; all authors reviewed a final version of the work before submission. Financial support. The authors report no financial support for this work. Potential conflicts of interest. J. R. M. reports that she is a member of the Infectious Diseases Society of America Inclusion, Diversity, Access & Equity Task Force; views expressed in this letter are her own and do not represent the task force. S. H. B. reports grant funding to her institution from Gilead Sciences. NF certifies no potential conflicts of interest. All authors have submitted the ICMJE form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.