All Work Hours Are Not Equal

We read Baird et al.’s¹  recent description of gender differences and trends in the anesthesiology workforce with great interest. As members of a large, vibrant academic level 1 trauma center with busy transplant and neurosurgical services, we observe that several issues raised by the 2013 RAND survey are relevant. We are a particularly diverse faculty group with a greater proportion of female anesthesiologists (49%) than represented in the study (26%).

At first glance, the conclusion that female anesthesiologists receive lower total and hourly compensation irrespective of the fewer hours worked is alarming. However, the context for this is the significantly three-fold greater part-time (defined as less than 35 h/week) employees in the female group, which in itself may explain the apparent discrepancy as 11% of that gender cohort. In a busy facility such as ours with increasing hospital demand for expansion of services, an employee working part-time in a 7 am to 3 or 5 pm shift adds value to meeting the elective needs of the operating room. However, a significant proportion of urgent and emergency service is provided after hours, on weekends, and on public holidays, and it is both plausible and logical for the larger full-time (by definition, larger male) cohort taking these calls to receive greater compensation. If, as the authors suggest, marital status and the presence of children affect gender hours, then on-call overnight and weekend hours must be valued more significantly than routine office hours.

With reasonable call shifts (14 h on weekdays and 12 h on weekends) and generous use of postcall days, it is not surprising that a faculty member taking calls, irrespective of gender, may not have significantly total increased hours compared to a weekday-only anesthesiologist. However, with increasing hospital demands, the flexibility of on-call faculty members to take additional pre- and/or postcall shifts is increasingly valuable and facilitates management of the daily schedule.

Given the increasing proportion of female anesthesiologists in almost all age groups documented in the article, there will also be an increasing proportion of part-time anesthesiologists, which may negatively impact both the on-call cohort and flexibility in schedule management. For these reasons, the decreased compensation for female anesthesiologists in the study may have a plausible explanation that was not proffered in the article.

The authors declare no competing interests.