Background
Gender disparities in medicine have been demonstrated in the past, including differences
in the attainment of roles in administration and in physician income.
Objective
Our objective was to determine the differences in Medicare payments based on the provider
gender and training track among female pelvic medicine and reconstructive surgeons.
Study Design
Medicare payments from the Provider Utilization Aggregate Files were used to determine
the payments made by Medicare to urogynecologists. This database was merged with the
National Provider Identifier registry with information on subspecialty training, years
since graduation, and the geographic pricing cost index used for Medicare payment
adjustments. Physicians with <90% female patients and those who graduated medical
school <7 years ago in obstetrics and gynecology or <8 years ago in urology were excluded.
The effects of gender, specialty of training, number of services provided, years of
practice, and geographic pricing cost index on physician reimbursement were evaluated
using linear mixed modeling.
Results
A total of 578 surgeons with female pelvic medicine and reconstructive surgery subspecialty
training met the inclusion criteria. Of those, 517 (89%) were trained as gynecologists,
whereas 61 (11%) were trained as urologists. Furthermore, 265 (51%) of the gynecology-trained
surgeons and 39 (80%) of the urology-trained surgeons were women. Among the urology-trained
surgeons, the median female surgeon was paid $85,962 and their male counterparts were
paid $121,531 (41% payment difference). In addition, urology-trained female pelvic
medicine and reconstructive surgery surgeons performed a median of 1135 services and
their male counterparts performed a median of 1793 services (57% volume difference).
Similarly, among gynecology-trained surgeons, the median female payment was $59,277
with 880 services performed, whereas male gynecology-trained surgeons received a median
of $66,880 with 791 services performed, representing a difference of 12% in payments
and 11% in services. With linear mixed modeling, male physicians were paid more than
female physicians while controlling for specialty training, number of services performed,
years of practice, and geographic pricing cost index (P<.001).
Conclusion
Although Medicare payments are based on an equation, differences in reimbursement
by physician gender exist in female pelvic medicine and reconstructive surgery with
female surgeons receiving lower payments from Medicare. The differences in reimbursement
could not be solely explained by differences in patient volume, area of practice,
or years of experience alone, suggesting that, similar to other fields in medicine,
female surgeons in female pelvic medicine and reconstructive surgery are not paid
as much as their male counterparts.
Key words
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Article info
Publication history
Published online: August 30, 2021
Accepted:
August 24,
2021
Received in revised form:
August 9,
2021
Received:
March 11,
2021
Footnotes
The authors report no conflict of interest.
Cite this article as: Dubinskaya A, Jackson FI, Labrias PR, et al. Disparity in Medicare payments by gender and training track in female pelvic medicine and reconstructive surgery. Am J Obstet Gynecol 2021;225:566.e1-5.
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