The Pay Gap in Medicine Is Real. Dr. Pamela Buchanan Is Done Being Quiet About It

Apr 2, 2026

Dr. Pamela Buchanan, emergency physician, author, and founder of Melanated Medicine, speaks bluntly about pay transparency, racism, and burnout in medicine. She recounts negotiating a $75,000 sign-on, the $100,000 pay gap Black women face, daily racist encounters on shift, and building a network for Black women physicians. Practical negotiation and mental health support are central topics.

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INSIGHT

How Practice Setting Drives The Pay Gap

Pamela links a persistent $100,000 pay gap for Black women physicians to practice settings and structural choices.
She argues many Black physicians work in lower-paying, altruistic settings like FQHCs, which depresses lifetime earnings.

ANECDOTE

Stethoscope Toss Prompted An Immediate Raise

Pamela narrates a lunchtime reveal where a colleague threw down her stethoscope and demanded she ask for a raise after learning Pamela's pay.
The chairman immediately agreed to increase pay and add loan repayment once confronted.

ADVICE

Hire A Contract Lawyer And Negotiate Loan Repayment

Get a contract lawyer before signing and research local market rates because pay varies widely by city and setting.
New grads should negotiate loan repayment and extras now since physician shortages give them leverage.

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Dr. Pamela Buchanan is an emergency physician, author, founder of Melanated Medicine, and one of the most candid voices in medicine on the things doctors aren't supposed to talk about.

In this episode of How I Doctor, Dr. Graham Walker sits down with Pamela to have the conversation most physicians have been trained their entire careers to avoid.

What does it actually cost to stay silent about pay?

What happens when a colleague throws a stethoscope on the ground and tells you that you're worth more than you're making? What does it feel like to be called the N-word by a patient you treat anyway?

Pamela doesn't flinch. She talks about the $100,000 pay gap Black women physicians face even when matched for the same role. She walks through the moment a friend told her to rip up a signed contract — and the $75,000 sign-on bonus that landed in her bank account 48 hours later. She speaks openly about burnout, depression, and the mental health crisis medicine refuses to name. And she makes the case that the silence around all of it isn't accidental.

This isn't a conversation about victimhood. It's a diagnosis of a broken system and a blueprint for every physician who's ever stayed quiet too long.

What You'll Learn

Why pay transparency in medicine isn't just taboo, and why Pamela believes the silence is intentional
How two candid conversations with colleagues changed her financial trajectory permanently
What to say, what to ask, and what to refuse when you're sitting across from someone offering you a contract
How racism shows up on shift — not occasionally, but every single day — and what it costs to absorb it alone
What Melanated Medicine is, why Pamela built it, and what happens when Black women physicians finally find each other
Why asking for help — professional, domestic, emotional — is not weakness but math

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