Assessment of Gender Disparities and Geographic Variations in Payments from Industry among Plastic Surgeons in the United States

Abstract

Background: Various medical specialties have demonstrated gender disparities involving industry-supported payments. The authors sought to determine whether such disparities exist within plastic surgery. Methods: Industry contributions to plastic surgeons practicing in the United States were extracted from the Centers for Medicare and Medicaid Services Open Payments 2013 to 2017 databases. Specialists’ gender was obtained through online searches. Kruskal-Wallis tests compared payments (in U.S. dollars) by gender (overall and by payment category). Linear regression estimated the independent association of female gender with increased/reduced payments while controlling for state-level variations. Results: Of 1518 plastic surgeons, 13.4 percent were female. Of $44.4 million total payments from the industry, $3.35 million were made to female plastic surgeons (p < 0.01). During the study period, female plastic surgeons received lower overall payments than male plastic surgeons [median, $3500 (interquartile range, $800 to $9500) versus $4160.60 (interquartile range, $1000 to $19,728.20); p < 0.01]. This trend persisted nationwide after normalizing for year [$2562.50/year (interquartile range, $770 to $5916.25/year) versus $3200/year (interquartile range, $955 to $8715.15/year); p = 0.02] and at the state level in all 38 states where there was female representation. Analysis of payment categories revealed that honoraria payments were significantly higher for male plastic surgeons [$4738 (interquartile range, $1648 to $16,100) versus $1750 (interquartile range, $750 to $4100); p = 0.02]. Within risk-adjusted analysis, female plastic surgeons received $3473.21/year (95 percent CI, $671.61 to $6274.81; p = 0.02) less than male plastic surgeons. Conclusions: Gender disparities involving industry payments exist in plastic surgery at both national and state levels. Factors contributing to this phenomenon must be explored to understand implications of this gap.

Open Payments Data Analysis of General and Fellowship-trained Surgeons Receiving Industry General Payments From 2016 to 2020

“…Rose et al’s 40 research concluded that female physicians received significantly less total amount of industry payments. The gender difference in industry payments has also been reported in later years with more data available on OPD 41–44 . There were only 5 surgeons (4.2%) identified as NHW women among the highest-paid surgeons in our cohort (>$500,000; n=120), and they received a significantly lower amount of payments compared with men, which is consistent with previous published studies and provides further evidence to confirm the inequality and industry payment gap.…”

“…The gender difference in industry payments has also been reported in later years with more data available on OPD. [41][42][43][44] There were only 5 surgeons (4.2%) identified as NHW women among the highest-paid surgeons in our cohort ( > $500,000; n = 120), and they received a significantly lower amount of payments compared with men, which is consistent with previous published studies and provides further evidence to confirm the inequality and industry payment gap. There is well-established evidence on gender disparities in promotion, salary, research funding, and academic ranking.…”

Article Factors Influencing Gender Disparities in Senior Authorship of Plastic Surgery Publications

“…Research shows that women hold fewer patents than men, and women who obtain patents are less likely to commercialize or license them 36,37 . Indeed, male plastic surgeons are more likely to receive payments for royalty or license 38 . In contrast, certain subspecialties within plastic surgery, such as breast reconstruction and aesthetics, may be viewed as more “female-friendly.” More women have chosen to specialize within such areas, 39 and female patients are more likely to request a female surgeon for breast and aesthetic surgery 40–42 .…”

Discussion: Assessment of Gender Disparities and Geographic Variations in Payments from Industry among Plastic Surgeons in the United States

“…1–6 The authors of “Assessment of Gender Disparities and Geographic Variations in Payments from Industry among Plastic Surgeons in the United States” 1 are to be commended for continuing a relevant and thought-provoking topic. Compared to previous work in plastic surgery and other medical specialties, Cunning et al 1 present a unique approach by specifically addressing industry payment differences over many years and across various practice settings. Their findings are consistent with similar studies that reveal that women receive less from industry in various specialties.…”

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G ender disparities in medicine and particularly in compensation have been well established, with various medical specialties reporting differences in industry-supported payments. [1][2][3][4][5][6] The authors of "Assessment of Gender Disparities and Geographic Variations in Payments from Industry among Plastic Surgeons in the United States" 1 are to be commended for continuing a relevant and thought-provoking topic. Compared to previous work in plastic surgery and other medical specialties, Cunning et al 1 present a unique approach by specifically addressing industry payment differences over many years and across various practice settings.

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