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.

中文翻译：

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女性骨盆医学和重建手术的性别和培训轨道的医疗保险支付差异

背景

过去已经证明了医学领域的性别差异，包括在管理角色和医生收入方面的差异。

客观的

我们的目标是根据女性骨盆医学和重建外科医生的提供者性别和培训轨迹确定医疗保险支付的差异。

学习规划

来自提供者使用汇总文件的医疗保险付款用于确定医疗保险支付给泌尿妇科医生的付款。该数据库与国家提供者标识符注册表合并，其中包含有关亚专业培训、毕业后的年数以及用于医疗保险支付调整的地理定价成本指数的信息。排除<90% 女性患者的医生和<7 年前妇产科医学院毕业或<8 年前泌尿科毕业的医生。使用线性混合模型评估性别、培训专业、提供的服务数量、实践年数和地理定价成本指数对医生报销的影响。

结果

共有578名接受过女性盆腔内科和重建外科亚专科培训的外科医生符合纳入标准。其中，517 人 (89%) 接受过妇科医生的培训，而 61 人 (11%) 接受过泌尿科医生的培训。此外，265 (51%) 名接受过妇科培训的外科医生和 39 (80%) 名接受过泌尿外科培训的外科医生是女性。在受过泌尿外科培训的外科医生中，女性外科医生的平均薪酬为 85,962 美元，而男性同行的薪酬为 121,531 美元（41% 的薪酬差异）。此外，受过泌尿科培训的女性骨盆内科和重建外科外科医生执行的服务中位数为 1135 次，而男性同行执行的服务中位数为 1793 次（数量差异为 57%）。同样，在接受过妇科培训的外科医生中，女性支付的中位数为 59,277 美元，提供 880 项服务，而接受过妇科培训的男性外科医生的收入中位数为 66,880 美元，提供 791 项服务，支付的费用相差 12%，服务费用相差 11%。在线性混合模型中，男性医生的薪酬高于女性医生，同时控制专业培训、服务数量、执业年限和地理定价成本指数。P <.001）。

结论

尽管医疗保险支付是基于一个等式，但女性骨盆医学和重建手术存在不同医生性别的报销差异，女性外科医生从医疗保险获得的支付较低。报销的差异不能仅仅由患者数量、实践领域或经验年数的差异来解释，这表明，与医学其他领域类似，女性骨盆医学和重建手术的女性外科医生的报酬并不高。他们的男性同行。