Your FQHC’s Market-Based Pay Program Causes Gender Inequity

Many health centers are only now developing the type of compensation programs they need to support their ever more complex organizations.  However, they are learning to do so at a particularly bad time.  Some years ago, the compensation profession turned its back on the sensible pay programs that had been growing and evolving throughout the business world, and allowed itself to fall prey to vendors (primarily market pay data vendors, not surprisingly) who told them that “market-based” pay programs were the answer to all their needs.  Since many health centers rely on the internet and the publications of human resources “professionals” to help them with their system design, they likely don’t even know that by doing so, they are enshrining and perpetuating gender pay inequity.

How does this work?  Isn’t following the market, by definition, “fair?”  After all, the Equal Pay Act and all our other employment discrimination laws allow for it, so it must be fair!

Nope.  Sorry.  The market discriminates.  We all know it does.  We all know that jobs typically held by women are paid less.  Why?  History, for one thing.  Bargaining power, for another.   Many women prefer flexibility, and will take less pay to achieve it.  When women are dominant in a profession, these “choices” will end up lowering the market rates.  Some female dominated trades are paid less because of the transitory nature of the employees in them.  In the FQHC environment, take Medical Assistants and Front Desk Receptionists as an example.  If their average tenure is only two or three years, they will never earn enough to “raise” the average rate in the market.

The bottom line is that the market does not take into account the value of jobs to an organization.  In even the most rudimentary job evaluation approach, we can see that jobs of equal value to the organization are often paid differently in the market.  We can also see how some jobs have more value in a health center than they do in the typical “health care” market.  We call our front desk people “the face of the organization,” and tell the world how they set the pace and quality for the entire patient experience.  Yet we don’t pay them commensurate with that value.

Many health centers think that they are actually paying enough, because “the survey says so,” yet when we stop to think about it, it is obvious that these jobs are harder, and require more skill, than in hospitals or private practice settings.  So how do we square this with when we pay a relatively low-skill maintenance person,  a trade dominated by men, several dollars an hour more, for work that has the same or less value to us.  When two jobs have equal value, we will always pay the one with the higher market rate what we need to pay — but paradoxically, despite the fact that we know that two jobs are equally valuable to us, we will take advantage of one group of people because the market allows us do it.

Sure, you can stick your head in the sand and say “well, as long as we don’t measure job value, we don’t have to know what we’re doing.”  Whether you use a formal internal equity model or not, jobs will still have the same value to your organization.  Whether you officially “know” it or not, you are still perpetuating a pay method that allows one group of people, providing the same value to your organization, to be paid less, solely on the basis of their gender.  Your employees will know that as well.

Rather than fighting a meaningless and silly battle against the supposed evils of “comparable worth,” simply because we don’t like where the message is coming from, employers should embrace the fact that the way to become an “employer of choice” is to show that they reward employees based the contributions they make.  Of course, it is also up to each and every employee to try and choose to work in places where employers actually value contributions — making employers see the value in doing that.

For more information on how creating truly equitable compensation plans is a business “best practice,” contact Merces.

[Note: a version of this post first appeared in The Compensation Times.  Visit The Compensation Times for articles about compensation that go beyond the health center environment]

About Edmund B. Ura

Edmund B. Ura, MAIR, JD, works with governing boards, executives and human resources staff to develop methodologies for ensuring fair and equitable compensation programs that support achievement of organizations' missions. Contact Ed at
This entry was posted in Compensation, Competitive Data, Organization, Performance Management. Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s