Women in Canadian medicine consistently earn less than men. • The pay gap between women and men exists within every medical specialty and also between specialties, with physicians in maledominated specialties receiving higher payments. • The gender pay gap in medicine is not explained by women working fewer hours or less efficiently but, rather, relates to systemic bias in medical school, hiring, promotion, clinical care arrangements, the fee schedule itself and societal structures more broadly. • Actions for closing the gap include antioppression training, challenging the hidden curriculum in medical education, fair and transparent hiring and referral processes, changing the relative value of fee codes and transparent reporting of physician payments stratified by gender.