Background. Male physicians have long earned more than female physicians, even after differences in the number of hours worked, specialty, practice setting, and other characteristics are taken into account. Whether earnings patterns have changed recently is not known. Methods. I examined data on earnings from the 1991 Survey of Young Physicians, a nationwide survey of physicians under 45 years of age with two to nine years of practice experience. The results were compared with data from the 1987 Survey of Young Physicians and with data on the earnings of physicians with 10 or more years of experience from the American Medical Association's 1991 Socioeconomic Monitoring System survey. Results. In 1990, young male physicians earned 41 percent more per year than young female physicians (male:female earnings ratio, 1.41; 95 percent confidence interval, 1.34 to 1.49). Per hour, young men earned 14 percent more than young women (ratio, 1.14; 95 percent confidence interval, 1.09 to 1.20). However, after adjustment for differences in specialty, practice setting, and other characteristics, no earnings difference was evident (ratio, 1.00; 95 percent confidence interval, 0.96 to 1.04). In general practice and family practice, women earned more than men, after adjustment for differences in other characteristics (ratio, 0.87; 95 percent confidence interval, 0.78 to 0.97). In internal-medicine subspecialties and emergency medicine, men earned more than women (ratio, 1.26; 95 percent confidence interval, 1.10 to 1.44). Among physicians with 10 or more years of experience, men also earned more than women (ratio, 1.17; 95 percent confidence interval, 1.07 to 1.27). Conclusions. Young male and female physicians with similar characteristics earn equal amounts of money. However, differences in earnings between men and women remain among older physicians and in some specialties. (C) 1996, Massachusetts Medical Society.