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In 2020, women earned 84 cents for every dollar that a male worker took home, a Pew Research Center analysis found.

Common explanations for this disparity—which is present across most industries and professions and is larger for minority women—include the perception that women are less likely than men to negotiate raises and promotions, women’s disproportionate childcare responsibilities, and stereotypes about women’s and men’s respective talents, which influence the industries they’re steered toward or from.

A new paper by Haas professors Mathijs de Vaan and Toby Stuart highlights an underexplored impact on the livelihoods of women—particularly those working in high-skilled, client-based professions—long after they’ve committed to their industry of choice. The researchers reveal that gender stereotyping can weaken clients’ perceived trust in female professionals’ core offering: their expertise.

“All high-skill, client-based markets depend on trust, because the consumer is a non-expert relative to the provider,” says Stuart. “If you hire a financial advisor, a mechanic, or a physician and you don’t trust them, what do you do with the advice they give you?” Most likely, he notes, you’ll seek a second opinion.

Drawing from the comprehensive Massachusetts All Payer Claims Database, Stuart and de Vaan examined whether physicians’ gender determined the perceived value of their expertise as measured by how often patients sought second opinions.

The majority of patients preferred seeing specialists who shared their gender, including for first-opinion visits. And both men and women were more likely to opt for second opinions if the purveyor of the first opinion was a female specialist. However, male patients were much more likely than women to seek a second expert opinion.

Male patients in particular tended to switch to male specialists for their second opinions—and since patients most often stuck with the second specialists, what naturally followed were significant disparities in billings. On a per-patient basis, female specialists generated 10.7% lower billings than their male colleagues in the year following the average patient’s first visit.

Stuart says gender stereotypes about competence may harm women with professional expertise in many fields, from finance to law to management consulting. “We hold all of these gendered beliefs about work even if we are not aware of them, and they have a way of becoming reality.”