Ophthalmology at the Veterans Health Administration: How Sex and Other Factors Affect Salary

Purpose: To determine factors that contribute to current salary differences among ophthalmologists employed by the Veterans Health Administration (VHA). Methods: We performed a cross-sectional analysis of full-time equivalent salaries of Veterans Health Administration ophthalmologists who received a federal salary in 2021. Differences in average salary with respect to various demographic variables were analyzed. Results: Data for 632 salaried VHA ophthalmologists (262 females [41.5%]) were included. Although biological sex alone did not have a crude, statistically significant effect on average VHA ophthalmologist salary (p = 0.116), a substantial discrepancy was noted in adjusting for other significant demographic variables, including years spent at the VHA. There was a significant interaction effect between sex and years at the VHA: female ophthalmologists initially earned substantially and significantly less than their male counterparts (−$9,726 [p = 0.018]). Regarding other variables, chief status and paygrade had the greatest effect on median overall salary, with an average increase of $33,673 for chiefs (p = 5.52e-11) and $28,472 for full-time VHA physicians (p = 1.96e-23). Years since residency (p = 3e-4) and h-index (p = 0.03) were each positively and significantly correlated with overall salary. All Veterans Integrated Services Network (VISN) regions, especially the Northeast region, were associated with significantly lower salaries compared with the Southern region. Conclusion: Female sex is associated with a significantly lower initial compensation for ophthalmologists employed by the VHA when adjusting for chief status, paygrade, VISN region, complexity level, academic rank, and years at the VHA. Although several factors could be involved in the apparent salary disparities found within this study, policy changes may be important to ensure compensation is equitable across VHA centers.