Tuesday, November 24, 2015

Analysis of the AOTA claim of a gender-based wage gap in occupational therapy

The American Occupational Therapy Association recently publicized a claim that although 90.9% of respondents in their workforce survey were women that male practitioners make 14.7% more than women, despite setting, years of education, or position.

 They added the following editorial comments: "Want to earn what you deserve and be more confident? You don’t have to join the boys’ club or be aggressive."

This is an interesting claim so I decided to research these statements and see if they could be validated.  Data on wage disparity was not previously collectible in OT because of low numbers of men responding to workforce or wage surveys.  There was a parallel problem in the nursing profession.  However, in a recent large scale study in the nursing profession (also dominated by women wage earners) male nurses made $5,100 more on average per year than female colleagues in similar positions (Muench, Sindelar, Busch, and Buerhaus, 2015).  However, the study reports that about half of that difference was accounted for by employment patterns and other measured characteristics like leaving the profession to raise children.  That leaves a small difference yet unexplained.  An economist for the American Nursing Association also reports that there is some volatility in the statistics based on the low numbers of men in the surveys. 

Peter McMenamin, a health economist and a spokesman for the ANA states “The folks who did the study are well qualified and they have lots of data,” he said. “But my main hesitance in terms of statistics is they have fewer men.” Only 7 to 10 percent of nurses are male, he acknowledged. But with a smaller sample, he said, “the reliability of the answers is less robust.” 

In sum, it seems fair and reasonable to state that some wage gap may exist but that small numbers of survey participants and the presence of unexplained confounding factors makes up for some of that difference.  It also seems fair and reasonable that there are likely to be similarities between female dominated health care professions, such as between nursing and occupational therapy.  Therefore, it seems in-bounds to look at data from other similar professions.

There is no real argument that there has been a historic gender-based wage gap but as gender roles have changed and evolved over the last several generations that wage gap has diminished.  Goldin (2014) provides an exhaustive review of the evolution of what she terms "gender convergence."  In simple terms, changes in gender roles and education and societal views have helped to drive wages closer and closer to equality.  The wage gap shrinks based on "explained" reasons related to role behavior but there is still a "residual" gap that requires analysis.  She explains that some people would attribute that residual gap to blatant gender discrimination or even due to women's alleged inability to bargain.  These attributions are in line with the AOTA statements.  These attributions are also not fact-centric.

 Through detailed mathematical and statistical analysis, Goldin identifies that the residual gap exists "because hours of work in many occupations are worth more when given at particular moments and when the hours are more continuous.  That is, many occupations earnings have a nonlinear relationship with respect to hours.  A flexible schedule often comes at a high price, particularly in the corporate, financial, and legal worlds."  Again, in simple terms, workers who require and/or take advantage of workplace flexibility do so at the peril of their own salaries.  It is a mathematically proven reality.

Therefore, evidence for the gap is not directly gender-related.  However, it is true that gender roles remain persistently traditional despite move towards convergence.  Everyone can apply their own anecdotes to this: my observations are that despite theoretical advancements in 'equality' it is still more likely for women to advantage workplace flexibility in order to meet other occupational demands.  If there are non-OTs reading this, I use the term 'occupational' in its broadest possible sense.

There is a difference between gender-based inequality and role-based inequality. It is unfortunate that people will conflate these concepts in order to suit a narrative. 

Goldin's research is corroborated by a U.S. Department of Labor study (2009) that reports that the gap can be brought down from 23% to between 4.8% and 7.1% once all of the "explained" reasons are controlled (human capital development, work experience, industry factors, and career interruptions).

What remains is the summary fact that economic analysis accounts for large amounts of any reported "gender-related" wage gaps.  The residual differential is unquestionably related to ways in which women tend to interact with their work environments, and whether or not that is reported as "gender discrimination" tends to vary with the political motivations of whoever is presenting the facts.  Again, there is a difference between gender inequality and role inequality.  You don't have choice over your biologic gender.  You have a lot of choice about the way you engage your roles.

Obviously there are some pockets of blatantly gender-discriminatory behavior in isolated workplace practices.  I don't feel the need to cite evidence to support that belief because after 35 years of employment I feel confident in the knowledge that discrimination can exist.  The question then is whether or not there is a culture of discrimination against women in the occupational therapy profession.

Perhaps the best way to test for this is to search for evidence related to the American Occupational Therapy Association's claims.  They reported that in order to get the salary you 'deserve' that "You don’t have to join the boys’ club or be aggressive."

After an exhaustive review I was unable to find any evidence that there is any kind of "boy's club" in the occupational therapy profession that is acting to suppress wages of women occupational therapists.  However, I did find documented evidence of what Peters (2011) described as an "old girl's club" and an "old girls' network" that used strategies like networking and mentoring to achieve their goals.  Peters explains that "In this connected system, community insiders watched over each other’s tutees who had ‘‘the right’’ occupational therapy pedigree."

Interestingly, the woman-dominated occupational therapy profession had an internal culture of 'taking care of each other' often to the detriment of anyone who was an 'outsider' to that network.  Peters describes several examples of gender, racial, and other forms of outsider bias that was perpetrated by the 'old girls network.' 

That is rather ironic.

In a more positive sense, Peters states that the network also openly identified the problems associated with conflicting home life vs. work life tensions.  Peters cites Jantzen (1972a, 1972b, Mathewson, 1975) that 34% of occupational therapists stopped working after ten years to raise families.  She explains that "One drawback to this pattern is that work discontinuation led women to be in a poor competitive position with men... typically, women continued to work around family needs first, placing them in a weaker economic position than working men... women experienced stress when balancing roles including wife, mother, homemaker, and worker with limited time..."  She also quotes Robert Bing

The real problem in the 50s was the fact that a typical OT practiced an average of 3 to 4 years, then disappeared, usually into marriage.  The schools could not turn out enough additional people to cover this loss.

It seems reasonable to believe that this pattern of concern persists into the present day.  These issues of discontinuous labor participation are faced by many women who choose to have children and who choose to take 'breaks' from their paid employment.

Peters' history goes on in rather extensive detail in describing and quoting a history of the occupational therapy profession that overtly promoted feminism and that overtly discriminated against men, rejected symbols of male dominance, and fought against any residual influence of a male-dominated medical system.  Her examples are not restricted to single anecdotes; she describes a culture that was pervasive and that was extraordinarily slow to change.  Peters concludes that

 Occupational therapy as a female dominated profession did not collapse or subsume to more dominant professions like physical medicine... rather than deferring, these women embraced gender inequities using their female networking strategies to overcome challenges... rather than becoming male-like or medicine-like, this female dominated profession strategically glorified its feminization as it became scientific, thus providing a unique template to gender specific professions.

There is no evidence of some 'old boy's club' that current therapists must avoid in order to 'get the wages that they deserve.'  That modern day OTs are subject to some specious narrative of victimization by social forces is not only historically incorrect but also in direct opposition to the economic analysis of respected scholars who have correctly described the nature of 'residual' wage gaps.  The actual historic evidence supports Goldin's research that describes the way women engage a career trajectory in context of a desire to also balance other life demands.  This is nothing new; female occupational therapists have been experiencing and documenting these challenges for many years.  These challenges are largely based on personal choices and not on gender-based discrimination.

The correct message for the predominantly female field of OT is to understand that they are not subject to a 'boy's club' mentality that is 'aggressive' and that suppresses the wages that they 'deserve.'  They also don't need to 'negotiate' better because that is not the problem.  These are all false narratives.

In the past occupational therapists have advantaged the reality of their own 'old girls' network' in order to support each other and to push forward.  I expect that there are residual forces within the profession that reflect that culture.  That old culture was never low on facts and high on finger pointing or excuse-making. 

I can't imagine that 'old girls' network' tossing down a blame card of discrimination and imagining a phantom network of gender-biased men who are protecting the club and holding down women's wages.  The narrative put forward on AOTA's social media is not supported by evidence.  Specifically, that narrative is not consistent with economic facts as explained by Goldin and as historically recognized by occupational therapists themselves.  It is also just not consistent with the cultural reality of this female dominated profession and the documented way it has framed its own challenges.

So is there a gap?  Probably not much of one if you adequately controlled for all the factors.  It is clear that any gaps that do exist are related to individual and personal choices people make about labor participation.  Evidence shows that OTs have known this and have documented this for years - and it has always been described in terms of occupational choices, not gender discrimination.

If a member association wants to raise the issue of the problematic nature of measuring and understanding salaries that is fine and actually should be encouraged.  Framing it in exaggerated terms without including an honest analysis of current economics and historical precedents is probably not helpful.


CONSAD Research Corporation (for USDOL) (2009).  An analysis of the reasons for the disparity in wages between men and women. Pittsburgh, PA: Author.  Downloaded from http://www.consad.com/content/reports/Gender%20Wage%20Gap%20Final%20Report.pdf

Goldin, C. (2014). A grand gender convergence: Its last chapter. American Economic Review, 104(4), 1091-1119.

 Muench, U., Sindelar, J., Busch, S.H., Buerhaus, P.I. (2015) Salary Differences Between Male and Female Registered Nurses in the United States. JAMA. 313(12), 1265-1267.   doi:10.1001/jama.2015.1487.

Peters, C.O. (2011) Powerful Occupational Therapists: A Community of Professionals, 1950–1980, Occupational Therapy in Mental Health, 27:3-4, 199-410, doi: 10.1080/0164212X.2011.597328

Tuesday, November 17, 2015

Sad days

"Today is my sad day," stated Lauren, in a matter of fact tone.

I work with many children who have superior language skills.  Often, those language skills outpace motor expression and emotional coping ability.  Sometimes doctors or psychologists call it a non-verbal learning problem or sometimes they will label it Asperger's Syndrome if the child has other behavioral quirks.  Either way, I am accustomed to hearing kids say things to me that would take the average listener off guard.

Lauren was a quick-witted and confident child with uneven red bangs from her own attempts at hair-styling.  Besides those bangs she had long tangled curls cascading down her back because she could not stand having her hair brushed.  Lauren had a habit of curling and twisting her hair in her hands, contributing to the tangles.  The mom intended to cut her hair to her shoulders but Lauren bargained herself a delay because she wanted long hair and also because she had the ability to perform verbal calisthenics and get things that she wanted.

I was seeing her because she had attention problems and some motor delays.  I know better than to respond too quickly, so I let her comment sink in a moment.  "What do you mean that 'Today is your sad day?" 

She reached into her backpack and pulled out a picture, directing it under my nose in a way that made me have to move my head back in order to focus.

"Today is the day that my dad died."

This was another one of those moments that you can never really be prepared for, because what do you say to a child that waves that information right under your nose?

It was an older picture with a deep fold down one side.  It was a picture of a baby, supported in her father’s arms, who seemed to be reflexively lifting her head to look at the other people surrounding her.  The baby had red hair; I imagine that it was probably as red as her father’s was when he was her age.  Now his hair was light brown.  As the baby looked at the strangers her dad teased the small curls in her hair with his fingers. 

"This is a picture of me and my Dad."  I knew that Lauren's dad died when she was a baby - her mom mentioned it to me during our first interview.  I started considering the pieces of the information that Lauren was giving me, and the implications of her statements started to fit together.

I stared at the picture and I thought how beautiful it was.  That dad loved his daughter.  Maybe his own parents held him the same way.  How else could he so effortlessly and perfectly hold his own daughter?  It was a perfect picture. 

"My mom told me that I used to be really fussy and all I had to do to calm down was let my dad hold me." 

I thought that was kind of funny, because little Lauren perceived her own intrinsic sense of control extending back to her infancy, as if she was letting her father hold her.  Her personality was so ingrained and she was only eight years old.  That made me smile.

"My mom told me that I would let my dad hold me on his chest and that would always make me close my eyes.  He would close his eyes, and I would close my eyes, and I would just listen to his heart beating and beating.  Sometimes I think I can still hear it, like when I am going to sleep and if I put my head on my pillow in a certain way.  Mom said that I am hearing my own heart, but I think I am hearing something else."

I stared at the picture that Lauren held in front of me as she talked and talked.  I imagined that it was his intention to remember this story himself twenty years after the picture was taken, and that she would not.  Instead she was developing a narrative of the event and she was doing the remembering. 

Death does that, I guess.  It takes the natural order of things and turns it all upside down.  Lauren now carried the memories that her father intended to have.

The story is now created and reinforced with the help of her mom.  It was originally supposed to be a love story that her dad had toward her.  What remains is a sense of love, but it is not the original love itself - because she only knows the story.  For Lauren that will have to be enough.

I thought about her uneven bangs, and her desire for long hair, and her ingrained habit of tangling it all together.  Then my perception shifted and I saw Lauren as a young woman, with long red hair that she would twirl wistfully with her own fingers.  I imagined her sitting and twirling her hair and dreaming about what it would be like to be loved.

She will understand that her father loved her, but she will know how that love was shown through a  shared and reconstructed story that will be as real as remembering the event herself.  Even on the sad days.