Gender Differences In Remuneration in Colorectal Surgery

Male surgeons perform more highly remunerated procedures in colorectal surgery than their female counterparts, contributing to a gender wage gap in colorectal surgery, according to an analysis of Medicare claims data.

Investigators examined nearly 63,000 Medicare claims submitted by board-certified colorectal surgeons between 2013 and 2017. Of these, only 16.9% were from female surgeons—a rate that increased annually, reaching 22.7% in 2017.

Analysis showed that, every year, male surgeons submitted more claims, submitted more highly reimbursed claims and used a greater number of procedural codes than female surgeons. Men and women were remunerated the same amount for performing the same procedures, but mean submitted charges per female surgeon in 2017 were $2,562 less than that for male surgeons ($16,614 vs. $19,176; P<0.0001). The same year, the average reimbursement for female surgeons was $4,193 compared with $4,962 for male surgeons, for a difference of $1,105 (P<0.0001).

At $689 per procedure, therapeutic endoscopy was the highest remunerated claim. Half of male surgeons who submitted Medicare claims performed therapeutic endoscopies, compared with only one-third of female surgeons (P<0.001). In 2017, male surgeons submitted claims for 675 polypectomies, the most commonly performed therapeutic endoscopic procedure; female surgeons submitted 107.

In comparison, 41.8% of female surgeons obtained the majority of their income from outpatient clinic procedures. These are the lowest remunerated procedures at $189.

The study also showed that male surgeons utilize a higher proportion of procedural codes compared with female surgeons (98% vs. 46%; P<0.0001). Of the 147 unique codes used in 2017, 77 were used only by male surgeons compared with three that were used only by female surgeons.

The study did not look at private practice wage contributions, rank, and seniority of surgeons or academic and educational pursuits.

Lead author Nathalie Sela, MD, an abdominal transplant surgery fellow at the University of Nebraska Medical Center, in Omaha, said the study could not account for factors driving this wage gap. Other studies have shown that female surgeons receive fewer referrals and are quicker to lose referrals after a single negative outcome. They’re also more likely to have smaller clinical networks (Am J Surg 2020;220[1]:69-75).

“Understanding this unique gender equity will allow current surgeons to offer greater support and mentorship for future generations,” Dr. Sela said.

This article is from the July 2021 print issue.