Women surgeons across several subspecialties receive lower pay
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Key takeaways:
- Women surgeons received less reimbursement per procedure and performed fewer highly reimbursed procedures.
- The differences could be due to variations in billing/coding strategies between women vs. men surgeons.
Women surgeons across three surgical subspecialties received lower reimbursement for fee-for-service procedures, submitted less charges and experienced lower practice volume vs. men surgeons, according to study results.
The findings indicate the variations in reimbursement may “perpetuate gender-based inequities,” the researchers concluded.
Salary differences
“Past studies suggest that salary differences between female and male surgeons are driven by academic rank, but these findings overlook surgeons outside of an academic/public setting,” Priya H. Dedhia, MD, PhD, FACS, surgical oncologist at The Ohio State University Comprehensive Cancer Center, told Healio. “Because our study implemented Medicare data, we were able to scrutinize billing differences in multiple contexts to understand factors that might drive gender-based disparities in reimbursement.”
Between November 2023 and February 2024, researchers sought to examine differences in practice measures and billing between 20,549 general surgeons (75.5% men), 1,065 surgical oncologists (57.7% men) and 1,601 colorectal surgeons (73% men) caring for a population of Medicare beneficiaries.
They assessed annual total submitted charges and payments in 2021, as well as the total number and types of annual services provided and the sum of beneficiaries treated. Researchers used multivariable linear regression models to evaluate the link between surgeon gender and payments, number of services and beneficiaries.
Surgeon gender served as the primary exposure of interest.
‘Reimbursement gap’
Results showed women surgeons billed less mean Medicare charges overall, with a 30.1% difference observed among general surgeons ($224,934.80 among women vs. $321,868.50 among men), 27.5% difference among surgical oncologists ($277,901.70 vs. $382,882.90) and 21.7% difference among colorectal surgeons ($274,091.70 vs. $350,146.10; P < .001 for all).
In addition, women surgeons received significantly lower mean reimbursements than men surgeons, with a 29% difference among general surgeons ($51,787.61 vs. $72,903.12), 23.6% difference among surgical oncologists ($57,945.18 vs. $75,778.22) and 24.5% difference among colorectal surgeons ($63,117.01 vs. $83,598.53; P < .001 for all).
Results of multivariable analysis also showed differences in reimbursement remained across all three surgical subspecialties:
- General surgeons: $14,963.46 (95% CI, $18,822.27 to $11,104.64);
- Surgical oncologists: $8,354.69 (95% CI, $15,018.12 to $1,691.25); and
- Colorectal surgeons: $4,346.73 (95% CI, $7,660.15 to $1,033.32).
“These findings aren’t surprising in the context of many studies demonstrating gender disparities in surgeon salary and other factors,” Dedhia told Healio.
Researchers reported study limitations, including the use of a large administrative dataset that could consist of “a lack of detailed information on work dynamics, including employment status (full-time vs. part-time), practice setting (academic vs. private practice), nature of tasks (clinical vs. administrative duties) and quality metrics, such as compliance with treatment guidelines.”
Future research
“Our work provides additional support for different practice and billing patterns between male and female surgeons and these differences may underly differences in compensation,” Dedhia said. “The next steps are to understand how billing patterns are associated with coding practices as well as patient outcomes. For example, do female and male surgeons code similar procedures differently? Also, female surgeons perform fewer highly reimbursed procedures — is tendency associated with a change in outcomes for similar patients?”
For more information:
Priya H. Dedhia, MD, PhD, FACS, can be reached at priya.dedhia@osumc.edu.
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