Among the factors that result in lower pay for female otolaryngologists compared to their male peers is that they typically perform less remunerative services. Results of a recent study found that female otolaryngologists had a decreased diversity of practice (i.e., billed for less unique codes on a per-physician basis), had lower productivity (i.e., billed for fewer services), and received fewer Medicare payments than their male peers. The study was published online on July 30, 2020, in JAMA Otolaryngology–Head & Neck Surgery.
To assess whether similar differences in clinical productivity and Medicare payments exist between female and male otolaryngologists, investigators from Harvard Medical School in Boston retrospectively looked at the CMS Physician and Other Supplier Public Use File for data on services provided by otolaryngologists in 2017, as well as payments made to Medicare in 2017 for outpatient otolaryngologic care in both hospital-based facilities (FB) and non-facility-based (NFB) settings such as physician offices.
A total of 8,456 otolaryngologists were included in the cross-sectional analysis. The study found disparities between female and male otolaryngologists in clinical activity and Medicare reimbursement assessed:
- Females submitted and billed fewer unique billing codes than males. Of the 834 unique billing codes submitted in 2017, 387 (46.4%) were from females and 804 (96.4%) from males; overall, females billed fewer unique codes per physician (-2.10 mean difference) than males.
- Among the 13,747,540 services rendered in 2017, females provided 1,396,422 (10.2%) and males 12,351,118 (89.9%), with females billing fewer services per physician (mean difference of -640).
- Medicare payments to otolaryngologists in 2017 were $687,028,998. Of this total, females received $71,683,065 (10.4%) and males $615,345,933 (89.6%), with females overall receiving less payment per physician than males (mean difference of -$30,346).
When assessed by type of practice, the study found that these gender differences were found in NFB settings but not FB settings.
“These differences were driven by findings in the ambulatory (non-inpatient) setting as compared to the hospital (facility-based) setting, which suggests that more progress toward gender equity has been made in hospital-based/inpatient settings that include academic otolaryngologists,” said lead author of the study Ashley L. Miller, MD, PGY-4 resident, otolaryngology–head and neck surgery at Harvard Medical School.
Dr. Miller emphasized that these results were based on the premise that female and male otolaryngologists are equal in terms of intrinsic factors such as surgical skill, motivation, and clinical acumen, and that the differences found in the study represent external institutional factors that can be mitigated with a more focused effort on issues of gender parity, such as equitable allocation of operating room block time and fair referral practices.