• Camille La Brooy, Hana Sabanovic, Susan J Méndez, Jongsay Yong, Anthony Scott, Adam G Elshaug, and Khic-Houy Prang.
• Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
• Intern Med J. 2025 Feb 8.

BackgroundThe gender pay gap in medicine is entrenched and has a negative impact on economic growth, institutional reputation and financial success, recruitment, retention and job satisfaction of female specialists and patient care. It also discourages women from entering specialist fields of medicine. In the Australian unregulated market setting, female specialists are not simply getting paid less, they are choosing to set lower fees than their male counterparts.AimsWe examine how implicit and explicit gender biases affect how fees are set and the potential role of price transparency in addressing the gender pay gap.MethodsWe conducted 27 semi-structured interviews with medical specialists recruited via social media and medical society newsletters between June 2021 and March 2022. Interviews were recorded and transcribed verbatim. Data were analysed using thematic analysis. Twenty surgeons and seven anaesthetists, 15 of whom identified as male and 12 as female, participated in this study. The primary outcomes and measures focused on the perspectives of surgeons and anaesthetists regarding fee-setting practices.ResultsA combination of contextual and market- and gender-related factors was the source of the biases that determine fee setting. Further, information asymmetry in medicine in Australia underlies current fee-setting practices, exacerbating and entrenching false perceptions about women's skills as surgeons and anaesthetists. Women tend to internalise these biases, self-regulating their behaviours and how they set their fees.ConclusionThe gender pay gap is pervasive. Greater transparency on fees and quality could be explored as a potential solution to reduce pay inequality.© 2025 The Author(s). Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.

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