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FQHCs, International Women’s Day, and Gender Pay Equity


The consulting firm Accenture yesterday released a report called Getting to Equal 2017, outlining its thoughts concerning how the gender pay gap could close in developed markets by the year 2044, 36 years earlier than previously estimated.  It sets forth three main ways to address this challenge: digital fluency, career strategy and tech immersion. Interestingly, all of these tactics are focused on things women can do individually to help themselves, and do nothing to address the systemic problems within the labor market that perpetuate the pay gap, and continue generally unabated.  Since women make up the vast majority of employees in health centers, there should be a conscious effort on the part of health center management to identify the problems in their organizations and address them, if not for “moral” reasons, than simply because it simply makes good business sense.

It would be hard to imagine a health center deliberately engaged in pay discrimination, and frankly, this is not where most of the problems occur.  The use of seemingly innocuous (and often “industry standard”) pay methods accounts for far more discriminatory impact that bold-faced discrimination:

  • Failing to recognize the value of jobs to the health center.  A truly fair pay plan will ensure that compensation opportunities are the same for jobs of equal value.  If a front-desk receptionist position has the same value to the health center as a maintenance person, for example, the pay opportunities should be the same, regardless of how other employers compensate people in these jobs.  While “value” may seem to be in the eyes of the beholder, there are simple and straightforward job evaluation models that allow any organization to see, in an objective way, how each job contributes to the organization’s success.   Taking this approach minimizes the inherent biases that occur when jobs are seen as “women’s” or “men’s” (or any other demographic characteristic, for that matter).
  • Relying solely on labor market data to establish pay opportunities.  Survey firms’ advertising notwithstanding, the quality of labor market data can be suspect at best, meaning relying on it alone to set pay is already a poor business practice.  However, since it is well known that there are inherent biases in the labor market impacting jobs typically held by women, using labor market data to set pay opportunities merely perpetuates the problem.  This is particularly problematic for entry-level jobs in the health center environment, such as front-desk staff, medical assistants and the like. As employers are thought to have more leverage on individuals in these generally less-skilled roles (because of their need for flexibility, desperation or other factors), they can be paid less.  As an employer you may feel that you are being “competitive,” but when “competitiveness” is based on an underlying bias, you may not be “fair.” Add to this the fact that “competitive market rates” are frequently insufficient to maintain a decent standard of living, the inevitable churning and turnover makes this type of approach a poor business practice.
  • Managing pay by negotiation.  It is said that part of the gender pay gap can be accounted for by women’s inability (or preference not) to negotiate aggressively. Internet articles  suggest that it is a woman’s obligation to “get what she deserves” through negotiation.  Our recent research indicates that in many health centers there is a gender pay gap for physicians, for example, that cannot be accounted for by any other factor; you may feel you are getting a break because your female physicians are not complaining, but to think that they don’t resent you is foolish.  The problem here is simple — if your pay plan can be impacted by individual negotiation, it is not a good pay plan. Employee compensation should be based on the value of the job and the performance of the individual alone, and if negotiation is allowed to change that equation, the credibility of the program is diminished.  You should not be putting the burden on your employees to fix the gap themselves; you should be paying everyone what they are worth, regardless of any of their characteristics.

As an industry, health centers should not be content with waiting another 27 years to fix a problem they could fix within a year.  Creating a compensation program free of gender bias, intentional and unintentional, should be one of the primary objectives for every health center.