Earnings and Earnings Disparities in the Veterans Health Administration and Other Healthcare Sectors.

Abstract

Many healthcare workers, particularly women of color, are poorly paid, and even among physicians, women and some minoritized groups earn less. Earnings inequalities are generally smaller in the public sector and might be attenuated in the Veterans Health Administration (VHA). To compare earnings and earnings disparities among VHA and non-VHA healthcare workers. Cross-sectional analysis of 2018-2022 American Community Survey data. Personnel in hospitals or outpatient care settings (n=591,265; weighted n=12,717,305/year, including n=358,118 VHA employees). Annual earnings overall and for individual occupation groups among VHA and non-VHA personnel; and gender-based or race/ethnicity-based earnings disparities assessed using linear regressions controlled for annual work hours and occupation. Mean earnings were higher in VHA than non-VHA settings; $88,964 (95% CI $86,373-89,754) vs. $81,125 ($80,718-$81,532), and pay inequalities were smaller in the VHA. Earnings in the VHA were lower for a few higher-income occupations, including physicians, whose earnings averaged $255,158 [95% CI 244,733-265,583] in the VHA vs. $286,090 [95% CI 283,613-288,567] in non-VHA settings, a difference (after control for annual work hours) of $26,702 [95% CI 15,691-37,713]. Gender- and race-based disparities were present but smaller in VHA than non-VHA settings. Adjusted for work hours and occupation, the pay disparity between women and men was $12,215 [$9151-$15,279] in the VHA and $26,859 [$25,981-$27,737] in non-VHA settings (p for interaction <0.0001). The adjusted earnings gaps for non-Hispanic Black vs. non-Hispanic white personnel were $5496 [$2384-$8608] vs. $9111 [$7825-$9093] (p for interaction = 0.015). Hispanic personnel earned less than non-Hispanic white personnel in both settings, and disparities were similar. Although physicians earn somewhat less in the VHA than in other settings, overall VHA personnel earn about 10% more on average, overall earnings inequalities are smaller, as are earnings disparities for women and Black personnel.