Gender-Pay Equity in Academic Neurosurgery at United States Public Universities

Kearns, Kathryn N.; Chen, Ching-Jen; Jane, John A.; Kalani, Yashar; Shaffrey, Mark E.; Park, Min S

doi:10.7759/cureus.8655

Cited by 3 publications

(5 citation statements)

References 18 publications

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“…While inequities in compensation and funding have improved in US public academic institutions when metrics of academic success are considered, there remain significant opportunities to address implicit prejudices that disadvantage under-represented groups in academic promotions, hiring for leadership positions, and institutional support for research. [35][36][37]…”

Section: Importance Of Diversity and Challengesmentioning

confidence: 99%

Racial and Ethnic Diversity in Neurosurgery: Challenges, Progress, and Future Directions

Wang,

Holly

2024

Neurosurgery

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Section: Importance Of Diversity and Challengesmentioning

confidence: 99%

Racial and Ethnic Diversity in Neurosurgery: Challenges, Progress, and Future Directions

Wang,

Holly

2024

Neurosurgery

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“…Factors such as age, location, specialty, rank, hours worked, and research output have all been cited as possible causes . Indeed, in neurosurgery, females tend to be more junior, underrepresented in higher academic ranks and leadership, and have lower research output metrics . Pay disparities persist across the medical field even after controlling for these variables …”

Section: Introductionmentioning

confidence: 99%

“…4,5 Indeed, in neurosurgery, females tend to be more junior, underrepresented in higher academic ranks and leadership, and have lower research output metrics. [6][7][8] Pay disparities persist across the medical field even after controlling for these variables. [9][10][11][12] While concerted efforts to increase representation of women in neurosurgery are ongoing, there has been little exploration of gender-based pay disparity in the field.…”

mentioning

confidence: 99%

“…[9][10][11][12] While concerted efforts to increase representation of women in neurosurgery are ongoing, there has been little exploration of gender-based pay disparity in the field. One recent analysis 6 concluded that gender was not associated with pay disparity; instead, pay disparity was associated with academic rank. However, that analysis was limited to public institutions within states that mandate reporting of employee salaries and, therefore, cannot be generalized to other settings.…”

mentioning

confidence: 99%

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Gender Differences in Medicare Practice and Payments to Neurosurgeons

Oshinowo,

Rallo,

Schirmer

et al. 2024

JAMA Surg

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ImportanceDespite efforts to promote diversity within the neurosurgical workforce, individuals from underrepresented groups face significant challenges.ObjectiveTo compare practice metrics and earning potential between female and male neurosurgeons and investigate factors associated with gender disparity in Medicare reimbursement.Design, Setting, and ParticipantsThis retrospective cross-sectional study used publicly accessible Medicare data on reimbursements to female and male neurosurgeons for procedural and evaluation and management services delivered in both inpatient and outpatient settings between January 1, 2013, and December 31, 2020. Data were analyzed from December 9, 2021, to December 5, 2022.Main Outcomes and MeasuresThe primary outcome was the mean annual payments received and charges submitted by female and male neurosurgeons for services rendered between 2013 and 2020. Secondary outcomes included the total number and types of services rendered each year and the number of beneficiaries treated. Univariate and multivariable analyses quantified differences in payment, practice volume, and composition.ResultsA total of 6052 neurosurgeons (5540 men [91.54%]; 512 women [8.46%]) served the Medicare fee-for-service patient population. Female neurosurgeons billed for lesser Medicare charges (mean [SE], $395 851.62 [$19 449.39] vs $766 006.80 [$11 751.66]; P &lt; .001) and were reimbursed substantially less (mean [SE], $69 520.89 [$2701.30] vs $124 324.64 [$1467.93]; P &lt; .001). Multivariable regression controlling for practice volume metrics revealed a persistent reimbursement gap (−$24 885.29 [95% CI, −$27 964.72 to −$21 805.85]; P &lt; .001). Females were reimbursed $24.61 less per service than males even after matching services by code (P = .02).Conclusions and RelevanceThis study found significant gender-based variation in practice patterns and reimbursement among neurosurgeons serving the Medicare fee-for-service population. Female surgeons were reimbursed less than male surgeons when both performed the same primary procedure. Lower mean reimbursement per service may represent divergence in billing and coding practices among females and males that could be the focus of future research or educational initiatives.

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“…Kearns et al noted that surgeon gender may not be the driving factor in pay discrepancies; instead, disparities may be mediated through differences in academic rank. These data were limited, however, to public institutions located in states in which the reporting of employee salaries was mandated.…”

Section: Introductionmentioning

confidence: 99%

Gender-Based Variations in Medicare Reimbursements Among Different Surgical Subspecialties

Munir,

Dillhoff,

Tsai

et al. 2024

JAMA Surg

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ImportanceGender inequities and limited representation are an obstacle to surgical workforce diversification. There has been limited examination of gender-based disparities in billing practices among surgeons.ObjectiveTo evaluate variations in practice metrics and billing practices among female and male surgeons and identify factors associated with gender disparities in Medicare reimbursements.Design, Setting, and ParticipantsThis retrospective cross-sectional study used publicly available Medicare Fee-for-Service Provider Utilization and Payment data from January to December 31, 2021, to identify demographics, annual services provided, and financial payments and charges for general surgeons, surgical oncologists, and colorectal surgeons. Data were analyzed from November 2023 to February 2024.ExposureThe primary exposure of interest was surgeon gender (ie, female or male).Main Outcomes and MeasuresThe annual total submitted charges and payments submitted in 2021 by female and male surgeons were assessed. Additionally, the total number and types of services provided each year and the number of beneficiaries treated were examined. Multivariable linear regression models were used to evaluate the association of surgeon gender with payments, number of services, and beneficiaries.ResultsA total of 20 549 general surgeons (5036 [24.5%] female; 15 513 [75.5%] male), 1065 surgical oncologists (450 [42.3%] female; 615 [57.7%] male), and 1601 colorectal surgeons (432 [27.0%] female; 1169 [73.0%] male) were included. Across all surgical subspecialties, female surgeons billed fewer mean (SE) Medicare charges (general surgeons: 30.1% difference; $224 934.80 [$3846.97] vs $321 868.50 [$3933.57]; surgical oncologists: 27.5% difference; $277 901.70 [$22 857.37] vs $382 882.90 [$19 566.06]; colorectal surgeons: 21.7% difference; $274 091.70 [$10 468.48] vs $350 146.10 [$8741.66]; all P &lt; .001) and received significantly lower mean (SE) reimbursements (general surgeons: 29.0% difference; $51 787.61 [$917.91] vs $72 903.12 [$890.35]; surgical oncologists: 23.6% difference; $57 945.18 [$3853.28] vs $75 778.22 [$2622.75]; colorectal surgeons: 24.5% difference; $63 117.01 [$2248.10] vs $83 598.53 [$1934.77]; all P &lt; .001). On multivariable analysis, a reimbursement gap remained across all 3 surgical subspecialties (general surgeons: –$14 963.46 [95% CI, –$18 822.27 to –$11 104.64] [P &lt; .001]; surgical oncologists: –$8354.69 [95% CI, –$15 018.12 to –$1691.25] [P = .01]; colorectal surgeons: –$4346.73 [95% CI, –$7660.15 to –$1033.32] [P = .01]).Conclusions and RelevanceIn this cross-sectional study, there was considerable gender-based variation in practice patterns and reimbursement among different surgical subspecialties serving the Medicare population. Differences in mean payment per service were associated with variations in billing and coding strategies among female and male surgeons.

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Gender-Pay Equity in Academic Neurosurgery at United States Public Universities

Cited by 3 publications

References 18 publications

Racial and Ethnic Diversity in Neurosurgery: Challenges, Progress, and Future Directions

Racial and Ethnic Diversity in Neurosurgery: Challenges, Progress, and Future Directions

Gender Differences in Medicare Practice and Payments to Neurosurgeons

Gender-Based Variations in Medicare Reimbursements Among Different Surgical Subspecialties

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