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    Mind the Gap: A Nobel Prize Winner’s Insight into Inequality

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    Headshot of Ruth D. Williams, MD.

    By Ruth D. Williams, MD, Chief Medical Editor, EyeNet

    Claudia Goldin was awarded the Nobel Memorial Prize in Economic Sciences in October 2023 for her rigorous research on the gender pay gap. She’s a brilliant academician who brings discipline and nuance to the discussion about wage issues, but it’s her expression in photos that grabbed my attention. Her visage exudes deep optimism, even joy, and it makes me smile. A reason for her joyful expression, and probably for her success, is revealed in her paper “The Economist as Detective.” In it, she writes, “Whatever you research, choose a subject (in theory or reali­ty) about which you feel passionately … you must simply crave the answers to the questions you pose.”1

    The questions Goldin asks are about why women, histor­ically, have been paid less in the workplace and what causes the shrinking but persistent pay gap. In an October 2023 announcement of the Nobel Prize winner, the Royal Swedish Academy of Sciences described her work as “the first com­prehensive account of women’s earnings and labour market participation through the centuries. Her research reveals the causes of change, as well as the main sources of the remain­ing gender gap.”2 Turns out, it’s complicated.

    It’s easy to throw around sound bites like “women earn 82 cents for every dollar a man earns.”3 It popped up last fall in a Freakonomics podcast about Goldin. This fact can elicit reaction, but it doesn’t shed light on the underlying issues. Goldin presents more sophisticated analyses and coined a term to explain the persistent wage gap: temporal flexibility.

    Goldin defines temporal flexibility as the ability to adjust work hours to attend to personal and family priorities. It can include the option to take a few hours off for a doctor’s ap­pointment or a school play, to end the workday at 3:00 p.m. in order to pick up kids from school, or even to take several months away from work for family reasons. Goldin proposes that the gender pay gap is caused by employers who impose economic penalties on employees who want fewer hours and more flexible employment.

    Goldin documents that the largest pay gaps occur in ca­reers with the least temporal flexibility, notably business and finance careers. Interestingly, among 1990 Harvard gradu­ates, a 10% employment hiatus in the 15 years after receiving their bachelor’s degree resulted in a 41% pay penalty for MBAs and a 15% pay penalty for MDs.4 In her pivotal paper, “A Grand Gender Convergence: The Last Chapter,” Goldin argues that the sectors of health care and information technology offer the most flexibility and the most linearity of earnings compared to time worked.5

    Many ophthalmologists would like to start work early, say 7:00 a.m., and end patient care by midafternoon. Patients, too, appreciate the option to be seen early in the morning, Saturdays, or evenings. When ophthalmol­ogists create these options for patients, it introduces flexibility for ourselves, too.

    Younger ophthalmologists say they value jobs that offer flexibility and time for personal pursuits. But I’m not sure it’s just young ophthalmolo­gists who want this. It seems like there’s a broader cultural shift in our specialty that is beginning to make allowances for physicians of any age—one that lets us be frank about our commitments to family, hobbies, and wellness.

    Reading her papers, it is obvious Goldin loves her work. In an increasingly high-pressure environment for physi­cians and staff, it’s valuable to create jobs with flexibility that enhance our quality of life. If most of us—men and women, young and less young—desire temporal flexibility, and if em­ployers recognize the value of creating flexible work hours, we just might narrow the remaining gender pay gap while promoting wellness and job satisfaction for everyone.





    4 Goldin C, Katz LF. American Economic Review. 2008;98(2):363-369.

    5 Goldin C. American Economic Review. 2014;104(4):1091-1119.