Women are an integral part of the radiation oncology workforce in Australia, New Zealand and Singapore, representing 40% of the workforce in 2018.1 Women radiation oncologists within the Royal Australian and New Zealand College of Radiologists (RANZCR) make significant contributions across all domains: clinical, research/academia, education, policy and advocacy. Alarmingly, the Australian Government's Taxation Statistics from 2018 to 2019 report that the average taxable income for women radiation oncologists was half that of men and the median taxable income was only one third.2 Could this gender disparity be accounted for by differences in full-time equivalent (FTE) hours worked? In the 2018 RANZCR Workforce Census, self-reported work hours were not markedly different between women and men, with a median of 40 versus 45 actual hours and 34 versus 37 clinical hours per week reported by women and men, respectively.1 However, these findings reflect work performed, not necessarily hours of paid work, raising the possibility that women perform more non-paid work in radiation oncology than men. A New Zealand study of 3510 medical specialists (including radiation oncologists) employed in public district health boards used census and taxation data to demonstrate that the age-adjusted hourly wage was 10% lower for women than for men, despite the hourly wage being higher overall for specialists who worked fewer hours.3 Another factor potentially contributing to the pay disparity might be remuneration arrangements. It has been previously reported that women Australian medical specialists are more likely to work exclusively in the public sector and less likely to have mixed public–private roles than men.4 Unpublished data from the RANZCR workforce survey found that 60% of women versus 49% of men reported having fixed incomes rather than incentive-based or mixed-source incomes. In the Australian public sector, incremental pay increases occur according to accrued time in service and career gaps such as unpaid parental leave can delay pay increases. In New Zealand, a majority of radiation oncologists work within the public health system, with an award based on accrued time, which specifies that specialists on paid parental leave continue accrual. Perpetuated pay gaps may result from men with equivalent credentials to women starting on higher salary scales at the commencement of employment, or receiving benefits associated with recruitment and retention.3 There has been minimal change in the proportion of woman medical specialists on the top salary scale, 23% versus 27% of women in 2015 and 2020, respectively, compared with 77% versus 73% of men.5 Incomes in the private sector can vary according to the contract and the number of patients treated. While there are no published gender-disaggregated data on private-sector earnings in radiation oncology, it has been previously demonstrated that women have poorer economic negotiation outcomes than men.6 Furthermore, in general practice (GP), where incomes are remunerated according to the number of patients seen, women spend more hours on non-billable work than men.7 In Singapore, some organisations pay men who join after National Service (mandatory conscription) higher starting wages,8 but do not pay women higher salaries when they come back from career breaks. Pay transparency is key to reducing gender disparities and should be adopted by both the public and private sectors. The deficit of women in administrative leadership roles, which attract higher remuneration, may also contribute to the pay disparity. While the RANZCR radiation oncology workforce census reported that men and women held leadership positions in similar numbers in 2018,1 this result was not broken down according to whether positions were associated with additional remuneration. At the time of writing, the number of women heads of public RANZCR radiation oncology departments, a leadership role remunerated at a higher pay level, was 11 of 34 (32%) (Table 1). There are currently no women heads of public or private radiation oncology departments in Singapore. One possible contributing factor could be the existence of a quota capping enrolment of women at one-third of the total students in Singaporean medical faculties from 1979 to 2002.9 The finding of a gender pay gap in radiation oncology reflects the wider pattern in Australia. Despite 59% of all university graduates in Australia being women, with respect to the size of the gap, Australia ranks 18th out of 38 Organisation for Economic Co-operation and Development (OECD) countries (1st being the smallest gap), behind middle-income countries such as Turkey and Colombia.10 The gender gap in the average weekly pay for a full-time employee in Australia has not improved over 20 years, with only a 2% decrease in 2020 compared with 2000.11 In the field of medicine, Australian data demonstrate that in 2017, the hourly earnings for men were 39% higher than for women, a disparity that remains largely unchanged over time. In Singapore, the adjusted gender pay gap across all job sectors was 6% in 2018.12 However, the largest pay gap reported in a 2017 study was for specialist medical practitioners, with women specialists making only 49.7% of men specialists' median income.13 In New Zealand, the gender pay gap across all sectors has remained stable for the last 5 years and in August 2021 was reported as 9.1%.14 Caring responsibilities and family commitments may contribute to the current gender gap. Traditional societal expectations dictate that women, particularly those of working age, carry most of the responsibility for childcare, other unpaid care and domestic duties.15, 16 Reduced income for radiation oncologists who are primary carers may result from maternity leave, a drop in FTE, or a perceived or actual inability to fulfil leadership roles and/or selection criteria due to care responsibilities. Additionally, employers in Australia are not required to make superannuation contributions for paid parental leave,17 creating further gender-based inequity. While not yet explored in the radiation oncology context, it has been previously demonstrated in the GP literature that GPs who are fathers earn more than male GPs without children, whereas the converse was found for women.18 Universal childcare, not yet available in Australia, New Zealand or Singapore, could help to partially address this issue for women in radiation oncology. Current governmental parental leave policies are another key factor that could be contributing to the pay gap. The current Australian policy does not encourage partners of women radiation oncologists to take on primary childcare responsibilities. The 18 weeks of parental leave is means-tested based on the birth parent or primary adoptive parent's earnings, meaning their partner would be unlikely to qualify for paid paternity leave.19, 20 This differs in countries such as Sweden, where a partner of the birth parent/primary adoptive parent can take up to 390 paid days of parental leave.21 Current policies also do not encourage male radiation oncologists to take on childcare duties. In New Zealand, doctors are entitled to 6 weeks’ paid parental leave if they are the primary caregiver, or 2 weeks’ paid parental leave if they are not.22 Those eligible for the statutory parental leave payment receive 14 weeks of full pay, with the district health board making up the difference above the government payment. When the paid parental scheme was introduced in 2003, 1.3% of those who accessed it were men.23 This figure has barely increased to 1.6% in 2020. In Singapore, fathers are allowed 2 weeks of government-funded paternity leave and may share 4 of their spouse's 16-week leave allowance.24 However, in 2018, 65% of eligible men did not take paternity leave and 97% did not take shared parental leave. Other current issues are potentially exacerbating the gender gap. The COVID-19 pandemic has affected women disproportionately, with more women losing employment, leaving the workforce, performing unpaid work (including supervising remote learning) and giving up study.25 The intersectionality of ethnicity, sexual orientation, socio-economic status, age and gender in our field also remains unexplored. We were unable to assess the pay gap for non-binary radiation oncologists. These findings highlight the need for further research and reporting in this area. Future workforce reports should include data stratified by gender and other socio-demographics26 and use recommended definitions and data collection methods.27, 28 Regular reporting will be important to monitor progress. The pay gap is only one example of gender-based inequity in radiation oncology. Other inequities and biases exist within medicine and academia relating to promotion, publication authorship, conference panels and harassment. Additional gender-based research in the RANZCR community is a priority, such as that conducted in North America with respect to evaluating gender differences in academic radiation oncology.29, 30 Furthermore, specific initiatives to promote the career advancement of women in radiation oncology are needed. The American Society for Therapeutic Radiation Oncology (ASTRO) has a diversity, equity and inclusion committee31 (DEI), which has resulted in initiatives such as a social education programme and a Leadership Pipeline Program. A similar committee could be considered within RANZCR. While mentorship and leadership programmes are available to some through RANZCR, these are not focused specifically on DEI. Elements of programmes, which harness the potential of emerging women leaders, such as the Franklin Women Mentoring Program,32 could be incorporated. Sponsorship, the public support of a colleague by an influential person from within the institution, can also play an integral role in career advancement.33 The importance of sponsorship for spotlighting unrecognised leadership potential of women should be acknowledged by institutions and RANZCR. Initiatives to encourage and support women to remain within the workforce despite primary carer responsibilities, such as more part-time appointments for trainees returning from parental leave, would benefit our speciality. The beneficiaries of the removal of the gender pay gap will not only be women; allowing women radiation oncologists to thrive and achieve their full potential in clinical work, education, academia and administration will provide benefits to their male colleagues, patients, organisation and wider society.34, 35 However, an improvement in the gender pay gap will require structural and cultural changes, starting with the recognition that inequity exists. The adoption of the core principles of DEI by workplaces, professional societies and research institutions should follow.36 The radiation oncology profession is known for its willingness to adopt change and advancement; it would be fitting for our profession to show strong leadership in the area of gender equity. Open access publishing facilitated by University of New South Wales, as part of the Wiley - University of New South Wales agreement via the Council of Australian University Librarians. Our data is unavailable to access or unsuitable to post due to research data is confidential.