You Choose: Do More Work for Free or Be Labeled as a Bad Colleague

— Women in health, especially women of color, are paid less and asked to do more

by
Jacqueline Mitchell, MS, and Mengyi (Zed) Zha, MD



March 26, 2024

When my (ZZ) boss asked me to take on teaching medical residents for free, I said “no.” Then his reply had my head spinning: “I want to empower you to think of compensation not as money, but as supporting your colleagues.” As a woman of color and a doctor, I was already doing countless hours of unpaid work, and even my paid work was under-compensated. Now, my new dilemma was do more free work, or be labeled a bad colleague.

“Your students don’t question your expertise, but they find you arrogant and intimidating.” My (JM) quarterly review read. As a woman of color and a professor of health sciences, my students had the highest passing rate on the state’s licensing exams, yet I was told “It might help if you smiled more.” Did my male colleagues receive feedback like this? I have only one guess.

Gender and racial pay gaps are more than a number after a dollar sign. There is an even larger work gap: the amount of unpaid work and unpaid non-work women, especially women of color (WOC), do day in and day out. Pay equality is a joke without work equality. And no one knows these “invisible” gaps better than two WOC in health education and healthcare.

But first, let’s talk about that dollar amount. Even though most teachers in the U.S. are women (75%), we make up only 35.7% of full professors, who enjoy higher pay. In colleges and universities, full-time women faculty make 82.3 cents for every dollar men make and this drops down to 67 cents on the dollar for WOC compared to white men. This means that on average, women professors make $16,000 less than male professors annually, a financial loss of $560,000 for a 35-year career.

Medical education doesn’t escape this pay inequality. In fact, even in certain women-majority academic specialties, such as obstetrics and gynecology, women faculty earned about $75,000 less than their men colleagues in 2016. Similarly, while eight out of 10 healthcare workers are women, in the three highest-paid physician specialties, less than 10% are women. The average female healthcare worker makes 25% less than men hourly.

While the median hourly wage for white women in healthcare is $21.24, this number is only $16 for Native American women, $15.38 for Black women, and $15 for Latina women. (Although Asian women had a median hourly wage of $24.73 in this study, there is a significantly smaller number of Asian women in healthcare in general and they tend to be in the higher-paying jobs like RN and MD, so it’s not an apples-to-apples comparison.) Also of note, equally qualified women physicians earn an average of $110,000 less annually than men. In primary care, this may translate into $1.8 million less over a lifetime.

Besides being paid less, women are asked to do more — for free. And this unpaid work, completed by women, holds communities and organizations together. Globally, an estimated 6 million women do unpaid or underpaid work in core health system roles, such as community health workers. Female primary care physicians spend 15.7% more time with each patient, 20% more time reading and analyzing patient records, and answer 51 more messages per month from patients than male physicians — to anyone who has worked in healthcare, that’s a lot of messages.

Health education mirrors the high expectations and lower relative compensation in clinical medicine. While teaching, I (JM) averaged 80-100 weekly hours during the academic year and spent much “free time” counseling students to ensure they had a positive learning experience — an expectation students did not report with my male peers. Male academic faculty can spend more time doing research, while women spend more time on teaching and other duties. Yet, men’s favorable evaluations mean they are more likely to get promotions, tenure, and ultimately, higher salaries and income.

Not only do women do more and get paid less, we are criticized for how we do it, too. While men can have their eyes on raises and promotions, women spend their precious energy juggling conflicting social and professional expectations — the unpaid non-work.

“Be knowledgeable but don’t forget to smile!”

“Don’t be selfish; do more work for free so your colleagues will like you!”

News flash: in contrast with men, women who are more successful are less liked anyway. So, we are doomed if we do well, doomed if we don’t. Additionally, we must balance being colorful without being too ethnic; competitive without losing femininity; strong without violating typical gender norms; assertive without being aggressive; and collaborative without claiming credit for our own contributions. Imagine walking a tightrope and carrying bowling balls while balancing plates — that’s what it’s like to be a WOC in the workplace.

There are certainly jobs in which women come out on top financially. Male models, for instance, make up to 75% less than female models. However, women in the modeling industry have uniquely short careers, which limit their lifetime earnings compared to male models, and the industry is no picnic for women. The air of modeling, particularly that of supermodels, is rarefied and limited. Even if Naomi Campbell comes easily to mind, WOC don’t have access to as many opportunities as white women, who are featured in 78% of all fashion ads. These “women-dominated” jobs represent a minute fraction of the workforce and do nothing to right the wage gap. We’re definitely not seeing the impact in our respective healthcare fields.

Since the Equal Pay Act in 1963, the pay gap has been closing at a glacial pace. At this rate, pay parity with men will not be achieved until 2056, and Black women’s pay parity with white men will not be achieved until 2130 — a number so far in the future that it looks more like a locker combination than a year. But it’s not enough to only talk about the $900,000 women lose to the pay gap over their lifetime. We must include the work gaps in this dialogue. Remember the 1800s rhyming couplet, “Man works till set of sun, woman’s work is never done”?

It’s 2024 and it’s time for women to be paid equally for all the work we do.

Jacqueline Mitchell, MS, is a professor emeritus in health, and works with BIPOC women in holistic health, disease prevention, and health restoration. She is also a community health advocate and educator. Mengyi (Zed) Zha, MD, is a physician in Washington and an agented nonfiction writer. Her work-in-progress is one on medical misogyny and racism.