The reasons for sex inequity in medicine are complex and partly interface ethnic background, specialty choice, and practice location. Multiple factors influence career choices including cultural values, balancing family responsibilities with professional growth, and career mentoring and support. Over the last 40 years, the Sophie Davis/CUNY School of Medicine (CSOM) has pursued a mission to increase diversity in medicine at the same time in which it has fostered the importance of primary care and service in underserved areas of New York State. Data from 1524 CSOM graduates show an increase in the number of women and underrepresented groups, with about a quarter of them working in Health Professional Shortage Areas (HPSAs). When compared with their male counterparts, our female graduates report lower income for similar work hours, with this disparity increasing slightly between female and male doctors working in HPSAs. In addition, our female graduates have chosen primary care specialties at a ratio of nearly 2:1 when compared with their male peers. Despite these inequities, our female graduates report satisfaction with their career choices, primarily due to a strong commitment to serving back patients in those communities where some of them come from. More research is needed to identify specific factors that perpetuate pay inequity at the state level to minimize the implications of disparity for women doctors, particularly those working in low-income communities.