When the Equal Pay Act passed into law almost 60 years ago, women working full time made 59 cents for every dollar earned by men. Since then, the gender earnings gap has narrowed but remains stubborn: A Pew Research Center analysis found that women earned 84 cents for every dollar that a male worker took home in 2020.
Common explanations offered 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 “lean in” and negotiate raises and promotions; women’s disproportionate childcare responsibilities; and stereotypes about women’s and men’s respective strengths and talents, which influence the industries they’re steered toward or from.
A new paper by Haas professors Mathijs de Vaan and Toby Stuart, published in American Sociological Review, highlights an underexplored way in which stereotyping can impact 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 banker, a mechanic, a management consultant, a financial advisor, or a physician and you don’t trust them, what do you do with the advice they give you? Do you follow it?” Most likely, he notes, you won’t follow the solution they’re recommending. Instead, you’ll seek a second opinion.
Gender and second opinions
Drawing from a rich dataset of medical claims information, Stuart and de Vaan examined whether physicians’ gender determined the perceived value of their expertise—as measured by how often patients sought second opinions.
They found that 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.
The researchers also quantified the cost of this greater doubt in female physicians’ expertise, and discovered that 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.
“We think the results would be similar in professional settings with the same characteristics: where the client is uninformed relative to the service provider, and where there are gender stereotypes about professional competence, which definitely exist in finance, banking, management consulting, the legal profession, and many others,” Stuart says.
Patterns in placing trust
Stuart and de Vaan drew from an uncommonly comprehensive dataset: the Massachusetts All Payers Claims Database, which contains information about the medical claims of nearly every Massachusetts resident. The researchers zeroed in on data about first-time visits to medical specialists for new-to-the-patient health conditions between 2010 and 2015.
Digging into the data, the researchers unearthed several gender-related patterns in the relationships between specialists and their patients. First of all, the majority of patients preferred seeing specialists who shared their gender, including for first-opinion visits; across the board, patients were 22% more likely to see specialists of the same gender than those of the opposite gender.
The researchers also noted that after an appointment with a female specialist, both men and women were more inclined to obtain a second opinion from another specialist than they were if the first appointment was with a male physician. This likelihood was much stronger among male patients—perhaps because some women’s preference for the expertise of a male physician was partially offset by the desire to see a doctor of their own gender.
Male patients in particular tended to switch to male specialists for their second opinions—and since patients seeking second opinions most often stuck with the second specialists for any recommended medical services, what naturally followed were significant disparities in billings.
Male patients contributed disproportionately to the 10.7% shortfall in female physicians’ patient billings. The researchers observed that when a female specialist saw a male patient, her average one-year billing amount for him was 18% less than the average billing amount for a male colleague seeing a male specialist. This difference was only 7% for female patients.
Shifting perceptions, then reality
Stuart says he hopes awareness about these stereotypes might start to lead to shifts in both perceptions and reality. For his part, Stuart found the patterns revealed by his research striking enough that he’s shifted his own behavior.
“I categorically refuse a male specialist now that I’m aware of this,” he says, explaining that it’s one way to provide his own counterweight, however miniscule, to the pervasive perceptions that over time create very real outcomes.
“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.”
Read the full paper:
By Mathijs de Vaan and Toby Stuart
American Sociological Review