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Sex-Based Disparities in the Hourly Earnings of Surgeons in the Fee-for-Service System in Ontario, Canada.
JAMA Surgery ( IF 15.7 ) Pub Date : 2019-12-01 , DOI: 10.1001/jamasurg.2019.3769
Fahima Dossa 1, 2, 3 , Andrea N Simpson 3, 4, 5 , Rinku Sutradhar 3, 6 , David R Urbach 1, 3, 6, 7 , George Tomlinson 8, 9 , Allan S Detsky 3, 9, 10 , Nancy N Baxter 1, 2, 3, 6
Affiliation  

Importance Sex-based income disparities are well documented in medicine and most pronounced in surgery. These disparities are commonly attributed to differences in hours worked. One proposed solution to close the earnings gap is a fee-for-service payment system, which is theoretically free of bias. However, it is unclear whether a sex-based earnings gap persists in a fee-for-service system when earnings are measured on the basis of hours worked. Objective To determine whether male and female surgeons have similar earnings for each hour spent operating in a fee-for-service system. Design, Setting, and Participants This cross-sectional, population-based study used administrative databases from a fee-for-service, single-payer health system in Ontario, Canada. Surgeons who submitted claims for surgical procedures performed between January 1, 2014, and December 31, 2016, were included. Data analysis took place from February 2018 to December 2018. Exposures Surgeon sex. Main Outcomes and Measures This study compared earnings per hour spent operating between male and female surgeons and earnings stratified by surgical specialty in a matched analysis. We explored factors potentially associated with earnings disparities, including differences in procedure duration and type between male and female surgeons and hourly earnings for procedures performed primarily on male vs female patients. Results We identified 1 508 471 surgical procedures claimed by 3275 surgeons. Female surgeons had practiced fewer years than male surgeons (median [interquartile range], 8.4 [2.9-16.6] vs 14.7 [5.9-25.7] years; P < .001), and the largest proportion of female surgeons practiced gynecology (400 of 819 female surgeons [48.8%]). Hourly earnings for female surgeons were 24% lower than for male surgeons (relative rate, 0.76 [95% CI, 0.74-0.79]; P < .001). This disparity persisted after adjusting for specialty and in matched analysis stratified by specialty, with the largest mean differences in cardiothoracic surgery (in US dollars: $59.64/hour) and orthopedic surgery ($55.45/hour). There were no differences in time taken by male and female surgeons to perform common procedures; however, female surgeons more commonly performed procedures with the lowest hourly earnings. Conclusions and Relevance Even within a fee-for-service system, male and female surgeons do not have equal earnings for equal hours spent working, suggesting that the opportunity to perform the most lucrative surgical procedures is greater for men than women. These findings call for a comprehensive analysis of drivers of sex-based earning disparities, including referral patterns, and highlight the need for systems-level solutions.

中文翻译:

加拿大安大略省按需付费服务系统中外科医生每小时收入中的性别差异。

重要性基于性别的收入差异在医学领域有据可查,在外科手术中最为明显。这些差异通常归因于工作时间的差异。为弥补收入差距而提出的一种解决方案是按服务付费的支付系统,该系统在理论上没有偏见。但是,目前尚不清楚,按工作小时数衡量收入时,按服务付费系统中是否存在基于性别的收入差距。目的确定在收费服务系统中,每小时花费的男性和女性外科医生的收入是否相近。设计,设置和参与者这项基于人群的横断面研究使用了来自加拿大安大略省有偿服务,单付费医疗系统的管理数据库。在2014年1月1日之间提出手术要求的外科医生,和2016年12月31日。数据分析于2018年2月至2018年12月进行。主要结果和措施这项研究在配对分析中比较了男性和女性外科医生每小时的手术收入和按外科专业划分的收入。我们探讨了与收入差异潜在相关的因素,包括男性和女性外科医生的手术时间和类型不同以及主要针对男性和女性患者进行手术的每小时收入。结果我们确定了3275名外科医生要求的1 508 471外科手术程序。女医生的执业年限少于男医生(中位[四分位数间距] 8.4 [2.9-16.6]年对14.7 [5.9-25.7]年; P <.001),从事妇科手术的女性外科医生比例最高(819位女性外科医生中有400位[48.8%])。女性外科医生的每小时收入比男性外科医生的小时收入低24%(相对比率,0.76 [95%CI,0.74-0.79]; P <.001)。在对专科进行调整之后以及在按专科进行分层的匹配分析中,这种差异仍然存在,其中心胸外科(以美元计:59.64美元/小时)和整形外科(以55.45美元/小时)的平均差异最大。男性和女性外科医生执行通用手术的时间没有差异。但是,女性外科医生通常以每小时最低的收入执行手术。结论和相关性即使在收费服务体系中,男性和女性外科医生在工作时间相同的时间也无法获得同等的收入,这表明,与女性相比,男性进行最有利可图的外科手术的机会更大。这些发现要求对基于性别的收入差异的驱动因素(包括推荐模式)进行全面分析,并强调需要系统级解决方案。
更新日期:2019-12-19
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