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Feature: In Pursuit of Equity: Examining Compensation Systems for U.S. Medical Faculty
I. A Case Study:The names in this case study are fictional, but the situation is very common. Could it occur in your medical school? Does it occur? Do you have systems to discover whether such occurrences are common? Does your school have processes in place to decipher whether the disparities are discriminatory or rational? Dr. Julia Sanders re-read the message from the financial officer of the Department of Medicine. The memo was a response to her request to add her colleague, Dr. Todd Jenkins, to the federal grant she was renewing. Both she and Dr. Jenkins were division chiefs in the Department of Internal Medicine. They had met during an orientation session for the hospital and faculty practice staff 7 years ago. Their families had celebrated together when first Julia and then Todd were named Division Chiefs last year. Todd's career led him to national distinction through his specialty society; and this year he had been voted president of that society. The Department Chair granted him a modest reduction in clinical time to accommodate his busy national schedule. Julia's career successfully blended clinical research with practice. She was pleased to be able to bring Todd onto her grant to compare different types of team-approaches to caring for patients with chronic disease. The grant would continue support of 60% of her salary, and she had offered Todd a 15% position to assist with recruitment of patients and consultation from his division. But now, after reading the memo, she realized she will have to adjust Todd's percent effort for the grant. She initially had estimated Todd's salary based upon her own, but his was $25,000 greater than hers. How could that be? Good friends that they are, Julia asks Todd to share his career and salary history with her. His response leads her to develop a comparison, which she prepares to share with the Chair:
How could it be that two professors with significant administrative positions and healthy academic careers could be compensated so differently? How does it happen that each advances without the knowledge of compensation policies and salary distributions within the same organization? Julia and Todd figured it out by comparing annual salary increases. Each had received 3% per year increases over their 7 years. Each had received increases as salary adjustments at the time of promotion and with the appointment as Division Chief. However, Julia had accepted her initial offers of $5000 with the promotion and $10,000 additional for the responsibility of Division Chief. Todd had pretty easily negotiated $7000 at the time of his promotion and $15,000 for the Division Chief position. The previous year, he received an additional $5000 for accepting a position as co-director of the residency program. Todd was surprised that Julia accepted so many new responsibilities without re-negotiating her time allocations and salary. "Every dollar adds up, Julia. You need to negotiate better." "You're right, Todd." Julia replied, "But my institution needs to monitor salaries and work assignments better, also." II. Salary Equity Studies: Experiences of Four Medical SchoolsRecent publications on inequities in salary and resource distribution and panel discussions during the 2004 Association of American Medical Colleges Annual Meeting have drawn attention to institutional practices to monitor faculty compensation patterns. The Council of Deans Administrative Board has encouraged all medical schools to entertain conducting such studies. In a March 2003 memo, the Chair of the Council of Deans, Dr. Darrell Kirch wrote, "Salary equity is an exceptionally important issue deserving of national attention. A proper analysis can be conducted only at an institutional level because relevant factors cannot be assessed on the basis of nationally available information." The challenge is not an easy one. The scenario between Drs. Sanders and Jenkins highlights the impact of unequal negotiation practices between two faculty with similar initial resources and job assignments. Most salary studies of medical schools, however, find significant variations due to differences in reimbursement of clinical activities, work assignments, and other measures of productivity. Salary models used in regression analyses of studies of equitable awards generally include consideration of academic position, years in rank of appointment, department and division, responsibilities for teaching and administration, and honors. Justifiable salary variations are likely to include measures of productivity such as RVU-based clinical activities or metrics of reimbursement for clinical services and financial support from grants and contracts. Speakers at the 2004 AAMC Annual meeting highlighted these metrics. Drs. Jeffrey Houpt (former Dean, University of North Carolina School of Medicine and former CEO, UNC Health Care System), Claudia Adkison (Executive Associate Dean for Administration and Faculty Affairs, Emory University School of Medicine), Kevin Grigsby (Vice Dean for Faculty and Administrative Affairs, Pennsylvania State University College of Medicine), and Ms. Patricia St. Germain (Associate Dean for Administrative and Financial Affairs, University of Arizona College of Medicine) spoke to the initiation, methodology, and outcomes of salary equity studies at their institutions. On several occasions, the in-depth look at salaries in their medical schools arose after publication of university-wide studies that failed to compare the myriad differences in job descriptions of medical faculty and, consequently, revealed more substantial disparities than the final medical-school based studies. For example, the University of North Carolina study in 2003 published an average discrepancy between male and female faculty salaries of between $7000 and $9000 dollars. Then-Dean Jeffrey Houpt immediately commissioned a study within the medical school, one that used the factors described above to compare populations of faculty with similar time in rank and work assignments. In the final analysis, 154 men and women were identified for an in-depth review of their salaries. Forty-five had already been adjusted as appropriate; Fifty-two, while low relative to peers, were viewed as appropriate; and thirty-six had departed from the institution. The salaries of thirteen(1.9%) of men and ten (3%) of women were identified for in-depth review and considered for salary increases, and a plan was put in place to correct them. Most of the disparity was attributed to a "loyalty tax," i.e. salary compression of long-term faculty members rather than any systematic discriminatory actions. The University of Arizona, GRACE (Generating Respect for All in a Climate of academic Excellence) project targeted the full University campus in a hypothesis-driven study that included quantitative salary studies and qualitative information from faculty. The results showed significant differences in perception of treatment at the College of Medicine by men and women. Analysis of variance of salary data showed twenty-eight women faculty were apparently under-compensated and who subsequently benefitted from salary increases. Dr. Claudia Adkison has been monitoring initial salaries, annual raises, and outliers for several years. In the course of routine monitoring, salary adjustments are made in consultation with chairs. When Emory University recently initiated a cross-campus study of salary equity, Dr. Adkison took on the challenge of educating the university committee about medical faculty responsibility and compensation while simultaneously responding to their inquiry. As a result of ongoing review and adjustments, few changes have been deemed necessary to respond to the University mandate. In contrast, a very recent study at Pennsylvania State/Hershey used an average of the results of three different regression models to compare salaries of similar groups of men and women faculty; subsequently, salaries were adjusted for almost 240 Penn State Medical School faculty members. Dr. Lois Haignere, author of the book, Paychecks, a Guide to Conducting Salary-Equity Studies for Higher Education Faculty and consultant for the Penn State School of Medicine study, writes of the strength of multiple regression analysis to compare populations of faculty with similar responsibilities and status. In her 2004 Annual Meeting presentation, she was clear that "multiple regression conceptually compares faculty with the same education, years of experience, discipline or specialty, and rank while measuring the impact of race and gender." It uses analysis of data to address the "yes, but" response to salary inequities. The response goes something like this: "yes, BUT women are paid less because they tend to have less education, or have fewer years of experience, or be in lower ranks or lower paid specialties, or be less productive." Good studies turn these hypotheses into measurable outcomes of compensation systems. III. Pearls/ Take Home Messages from AAMC Annual Meeting Discussions
For further references on Studies of Resource Equity, consult the References section in this issue. - Diane Magrane, M.D., AAMC |
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