Eyeworld

July 2016 • Ophthalmology Business 13 children that we take care of as pedi- atric specialists are on Medicaid. It's a problem with the field of pediatrics in general," Dr. Christmann said. She also said glaucoma recently took a hit in reimbursement due to Medicare cuts, so estimating future earnings is harder than ever. Choice in subspecialty is not the only factor that could have women making less. The type of practice a woman goes into could make a differ- ence. Dr. Christmann said ophthal- mologists who are "self-employed" (working in private practice) tend to make more than those who are "em- ployed" (working for multispecialty groups, in academic settings, or for an HMO). Women, she said, are more likely to find themselves in the latter, preferring it perhaps for reasons such as job security. Still, there's even more that plays into gender differences in ophthal- mology. Other reasons why it may seem women in the field earn less as a whole could be age. Dr. Christmann said while more than 40% of trainees these days are women, ophthalmolo- gists with seniority are far more likely to be men. Less experience in the field, still developing surgical prac- tices, and more could equate to the appearance of smaller overall salaries. "When you peel the onion to get to the heart of the question, there are some reasons why women get paid less that are based on decisions the women themselves have made," Dr. Christmann said. "However, there is also unquestionably both conscious and unconscious bias, and that's what we need to work against." To combat this bias, 1 of the fac- tors Dr. Christmann and her fellow members at Women in Ophthalmol- ogy focus on is negotiation. "Women tend not to negotiate, so we're trying to include education on that in our annual meeting each year," Dr. Christmann said, noting that negotiation tactics don't just have to advocate for a higher salary. Things like work from home days for administrative duties and other ben- efits could "sweeten the pot." Ophthalmic Women Leaders (OWL)—an organization of ophthal- mologists and ophthalmic business and industry leaders promoting diverse leadership with the goal of enhancing innovation and patient care—conducted a survey in 2015 that found most people—male and female—considered their salaries to be average. However, 25% of female respondents perceived their sala- ry as being lower or slightly lower. The survey also found that women were actually more likely to negoti- ate than men, but there might be a reason. "Looking a bit further in the survey results, 70% of male respon- dents were satisfied with the offer so they didn't feel the need to negoti- ate, whereas only 41% of the female respondents were satisfied with the offer they received. This led to more likelihood for them to want to ne- gotiate," said Heather Ready, OWL president. Despite more women negotiat- ing, Ms. Ready said 50% of female respondents were not confident in having such negotiations. "It is important for all employees to feel that they are fairly compen- sated, so getting comfortable with the negotiation conversation is important," said Angela Bedell, OWL executive director. Outside of salary, the survey found there were twice as many men in executive positions compared to females. The majority of female MDs surveyed (85%) said they found it difficult to participate in clinical trials, consult with industry, speak at professional meetings, and/or serve in leadership positions, citing discrimination, time constraints, and contractual issues as reasons why. Dr. Christmann said that women might see "plum jobs," like doing clinical research for a company, being offered to men, but on the flip side, she said women also need to have the confidence to ask if they want such opportunities. "It's not necessarily the company's fault. If women are not approaching them, they're not going to choose women," Dr. Christmann said, noting that women might not be privy to some of the networking that leads to such opportunities. Over the last few decades, Dr. Christmann said there has been progress toward giving female oph- thalmologists more representation in organizations, bringing them into leadership roles, and increasing their participation in public speaking events, but there's still more to do. A study published in JAMA Ophthalmology in 2015, for example, found that the percentage of oph- thalmic publications where women were listed as the first author in- creased from 2000 to 2010. 2 Edito- rials though, which Dr. Christmann said are an honor because they are authored by those on an editorial board, a prestigious position, were dominated by men. Of the 38 edito- rials from 2000 included in the obser- vational retrospective study, 33 were written by men, and 46 of 51 in 2010 were written by men. While Dr. Christmann said she thinks most are aware of the disparity between male and female ophthal- mologists, driving positive change is like "turning the Titanic." "I know a lot of physicians have picked up on it. The question is how many will take action?" Dr. Christmann said. OB References 1. Davis J. Physician careers: understanding the market. Doximity. Jan. 27, 2016. blog. doximity.com/post/138152892296/physician- careers-understanding-the-market 2. Franco-Cardenas V, et al. Decadelong profile of women in ophthalmic publications. JAMA Ophthalmol. 2015;133:255–9. Contact information Bedell: abedell@owlsite.org Christmann: kindes.auge@gmail.com Ready: Heather.Ready56@gmail.com

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