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

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


Unknown said…
I am not sure why you chose to focus on the comment following the statistic instead of the disparity in wages. The "old boys club" most likely isn't within the OT departments of the world, but rather in the institutions and agencies that employ OTs. Furthermore, your comments about women "disappearing" from the workforce reveals your limited understanding of the issue of workplace inequality. Other developed counties have policies in place that support families, especially women, so that careers don't have to suffer for childrearing. It's actually part of the point of shining a light on workplace inequality.
Dear Unknown,

If you have evidence of an 'old boys club' that is unevenly suppressing the wages of female occupational therapists I hope you will share it. Any empirical data that you can offer to support your belief would be helpful, because if such evidence exists I suspect that many good people would be interested in addressing such an injustice.

The comment about women 'disappearing' from the workforce is not my construction; if you read the post you will see that it was made by several other occupational therapists (both men and women) - Jantzen, Matthewson, and Bing - all in separate analyses. Based on my observations these statements are probably accurate. They are also in line with what other researchers (outside of OT) make about the discontinuous nature of workforce participation of women as compared to men. You might not like that fact, but it is a fact nonetheless. I am simply reporting what others have reported.

Again, if you read the post carefully, any small gap that does exist is related to occupational choices and not gender discrimination. I appreciate your comments, especially since not many people are interested in addressing this issue. I think it is important for us all to talk about because I believe there is gender discrimination in some employment contexts. I just don't happen to see this as a significant problem for female dominated professions like nursing and occupational therapy - and that is supported by quite a bit of research.

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