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Gender Wage Gaps in

Health Care Occupations

John Schmitt, Eileen Appelbaum and Rosemary
Industry Studies Association
Nashville, Tennessee
May 31, 2019
Research Question
• Economy-wide gender pay gaps have been
decreasing since the 1970s, but significant
differentials persist in U.S.

• Healthcare is one of the most important

sources of jobs in the economy
• Health care spending was $3.3 trillion in
2016, 17.9 percent of GDP
• Dec 2017 HC employed 15.92M workers,
12.7% of private sector jobs

• How large are gender wage gaps in HC?

Prior Research
• Excellent review by Blau and Kahn (2017)
• Evaluate a dozen possible explanation for gender wage gap
• Conclude that industry and occupation account for half
• Little role for other explanations

• Folbre 2017, Folbre and Smith 2017

• Care work penalty due to difficulty measuring effort and
efficacy, ‘joint production’ with care recipients,
• Should apply to both men and women in care settings, but
do men get rewarded & women penalized for caring?

• Darity 2017 and others

• Too much emphasis on characteristics of individual
• Preserving status of group plays a role in how dominant
group (men) behaves toward subordinate group (women),
can affect material well-being.
Gender Wage Gap in Health
• Industry & occupation – single most important
explanation for contemporary wage gap

• Examine gender wage gap in

• Two related HC segments – hospitals,
• Eight relatively narrow occupations
• Controls for age, education, race, nativity,
state in ACS
• Additional controls for part-time, union in
Industry and Occupation
Industry Segments (2)

• Hospitals
• 2015: 5.76 million workers, 36.4% of all HC workers
• Employment growth 2005-2015: 9.7%
• Outpatient Care Centers
• 737,410 workers , 4.7% of all HC workers
• Employment growth 2005-2015: 58.4%

Occupations (8)
• Food services, Cleaning services, Health Aides,
LPNs/LVNs, Social services, Medical technicians,
Practitioners, Physicians
• Large gender wage gaps in seven of eight

• Generally larger for black, Hispanic women

than for white or Asian

• Contrary to other studies, we find these gaps

are as large or larger in low-wage occupations
as in highest paid

• Black and Hispanic men as well as women face

large wage gaps relative to white men in most
• Main data are from ACS 2016
• Large sample size – survey of 250,000 per
month, legally required to respond (95%
response rate)
• For workers employed less than full year,
weeks worked are in wide bands (1-13, 14-
26, 40-47,48-49, 50-52)
• Difficult to calculate accurate hourly wage
for these workers
• Analyze full year, full time workers

• Also analyze CPS - Outgoing Rotation Group

• Sample size is smaller
• Ordinary least squares wage regression

• Regresses natural log of hourly wage against a

binary variable for gender (FEMALE) and
control variables

• Coefficient β on FEMALE is estimate of gender

wage penalty (in log points), controlling for
other factors

• Log points can be converted to % for small

values by moving decimal point 2 places to the
• Data presented here show substantial gender pay gaps
in 7 of 8 relatively narrow occupations in 2 HC segments
• Even after controlling for age, education, industry
structure, race and ethnicity, state, and in CPS
regressions part-time, union
• Women earn 6 to 17% less than men in same occ,
same HC segment
• Wage gaps as large for low-, middle-wage as for
high-wage occupations

• Traditional models of discrimination – tastes, or average

group characteristics (statistical discrimination) not

• Group-based stratification appears to play a role – may

be a fruitful path for future research