Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Despite ongoing efforts to address the gender pay gap, significant wage discrepancies and differences in lifetime earnings persist between male and female physicians. Prior studies in the U.S., particularly in the fields of cardiology, neurosurgery, and orthopedic surgery, have consistently demonstrated that female physicians receive lower Medicare reimbursements compared to their male counterparts. These disparities cannot be entirely attributed to variations in practice diversity or patient volume. To further understand potential gender disparities across subspecialties, we aimed to examine the association between surgeon gender and Medicare practice patterns and payments among otolaryngologists.
Methods: This retrospective cross-sectional study analyzed publicly available Medicare data on reimbursements to male and female otolaryngologists for procedural and evaluation/management services provided in both inpatient and outpatient settings from January 1, 2013, to December 31, 2022. The primary aim was to assess gender-based differences in reimbursement and billing practices among otolaryngologists. Secondary objectives included evaluating mean gender-based differences in clinician demographics, patient volume, and services provided. The data set from Medicare was cross-referenced with the National Plan and Provider Enumeration System Downloadable File using National Provider Identifier numbers. Univariate and multivariable analyses quantified differences in reimbursement, practice volume, and services.
Results: The study included 11,002 otolaryngologists (9,166 men [83%]; 1,836 women [17%]). Male physicians treated an average of 656 patients annually, while female physicians treated 479, marking a significant difference in patient volume (p < 0.001). When analyzing the distribution across four U.S. regions (Northeast, Midwest, South, and West), the South had the highest proportion of otolaryngologists (37.5% vs. 21.6% in the Midwest, 20.7% in the West, and 20.2% in the Northeast). Regional differences were identified by gender, with males representing 84.4% of otolaryngologists in the South (vs. 84.2% in the Midwest, 82% in the Northeast, and 81.6% in the West). Nationwide, males constituted over 80% of the otolaryngology workforce across all regions (p = 0.01). Gender-based differences also appeared in reimbursement, in the latest available year of practice data, female otolaryngologists were reimbursed $17 less per service than their male counterparts for identical services (P ≤ 0.001). Additionally, female otolaryngologists billed for lower Medicare charges (mean [SD], $119 [$169] vs. $141 [$299]; P < 0.001) and received less in reimbursements (mean [SD], $88 [$134] vs. $106 [$239]; P < 0.001). Multivariable regression analysis, adjusting for practice volume, geographic region, and years in practice, confirmed a persistent gender-based reimbursement gap, with females receiving an average of $20 less per service (95% CI, −$25 to −$16; P < .001).
Conclusion: This study identified substantial gender-based disparities in practice and compensation among otolaryngologists serving Medicare fee-for-service patients. Female otolaryngologists are reimbursed less than male otolaryngologists even after adjusting for geographic location, experience, and practice volume. Our findings suggest that factors like practice diversity and procedure coding may contribute to this wage gap. Further research is needed to better understand such practice and reimbursement disparities. Addressing these inequities is essential for both ensuring appropriate compensation and supporting a diverse and inclusive healthcare workforce, particularly among surgical subspecialities.