The Gender Gap in Surgeon Salaries - Striving to achieve pay equity

Total knee arthroplasty reimbursement is declining overall and at a marginally faster rate amongst female orthopaedic surgeons: A Medicare analysis

Background

While the prevalence of total knee arthroplasty (TKA) is increasing, reimbursement is declining. The purpose of this study was to determine how surgeon gender influences procedure volume, reimbursement, practice style, and patient demographics for TKAs nationally and regionally between 2013 and 2021.

Methods

The Medicare Physician and Other Practitioners database was queried from 2013 to 2021 for procedure volume, TKA reimbursement, surgeon characteristics, and patient demographics for any surgeon who performed at least ten primary TKAs per year. Statistical tests were conducted to analyze differences based on surgeon gender, geography, and year.

Results

Of the 2,415,802 TKAs performed between 2013 and 2021, 1.5 % were billed by female surgeons. The number of TKAs performed annually increased by 29.1 % for female surgeons and decreased by 2.6 % for male surgeons. Between 2013 and 2021, reimbursement for TKAs decreased by 23.9 % for male surgeons and 26.2 % for female surgeons. In 2021, male surgeons were reimbursed $1017 per TKA while female surgeons were reimbursed $964 (p = 0.049). Male surgeons performed more TKAs annually in 2021 (Male: 39.3, Female: 30.9, p < 0.001), more total billable services (Male: 4148.0, Female: 2719.3, p < 0.001), and more unique billable services (Male: 70.7, Female: 55.3, p < 0.001) than female surgeons.

Conclusions

Female representation among surgeons who perform TKAs is increasing nationally. However, male surgeons treat more patients, perform more total billable services, and perform more unique billable services than female surgeons. TKA reimbursement is decreasing at a faster rate for female surgeons than male surgeons, although this is likely due to geographical differences.

The gender gap in academic surgery: the electronic health record

BACKGROUND

The electronic health record (EHR) contributes to burnout, and excessive EHR work impedes productivity. The scope of potential gender discrepancies in EHR burden among surgeons is unclear. Because clinical operations and workflow vary by institution, EHR research must be conducted at multiple centers. Identifying modifiable factors that influence how surgeons use the EHR would support strategies that mitigate gender discrepancies. We hypothesized that gender differences in EHR use would be related to EHR support from clinical team members, patient message volume, and documentation length.

METHODS

We retrospectively evaluated EHR use by surgeons from multiple specialties in eight departments at a large academic center from January to December 2023. Data about clinical and EHR workload were collected using a provider efficiency tracking tool. These data included the amount of time surgeons spent working in the EHR outside of regular work hours overall and on individual tasks such as responding to messages, clinical review, and orders; the number of messages received and their source; proficiency with documenting in the EHR; and receipt of assistance with EHR documentation and orders from clinical team members.

RESULTS

EHR use was analyzed from 323 surgeons (32% women). After adjusting for specialty, women spent more time than men working in the EHR outside of scheduled clinical hours (mean difference: 7.8 min/day; p = 0.001) and 7 AM to 7 PM (3.8 min/day; p = 0.007) despite no difference in clinical workload. Women spent more time on notes (1.8 min/appointment; p < 0.001), messages (0.7 min/appointment; p = 0.004), and clinical review (0.6 min/appointment; p = 0.032) than men. However, there were no surgeon gender differences in clinical support for EHR work, number of patient messages, note length, or proficiency with the EHR.

CONCLUSION

Women surgeons had a greater EHR burden than men at our institution. Assuming 16 clinical days/month, 8 min/day of additional EHR work outside of scheduled clinical hours for women translates to approximately 26 h/year of lost time relative to men. Unequal EHR work may increase the gender gap in career advancement and exacerbate burnout for women. Future research should include prospective multi-center trials to clarify the extent of the surgical EHR gender gap.

Women Surgeons: Barriers and Solutions

BACKGROUND

Underrepresentation and undertreatment of women in surgery continues to be highly prevalent, with major barriers to improvement. The aim of the study was to review the current state of women surgeons in Poland.

METHODS

Information from the various Polish databases on women surgeons in 9 medical universities in general, oncological, vascular, thoracic, and cardiac surgery was retrospectively evaluated. Demographics of residents and staff surgeons, academic ranks and leadership positions at universities, in surgical societies and on scientific journals editorial boards were analyzed. Descriptive statistics were used.

RESULTS

In 2020, 61% of 3,668 graduates of Polish medical universities were women. In 5 surgical specialties, 11.9% (1,243 of 10,411) of the surgeons were women, with the lowest numbers in cardiac (5.6%), and in vascular surgery (6.4%); 40.4% of general surgery residents were women, less in vascular (18.4%) and thoracic surgery (24%), more in oncological surgery (28.7%). In 35 surgical departments of 9 universities, all department chairs were men, all full professors were men; 7% of associate professors and 16% of assistant professors were women. Rectors of all universities were men; 27% of the vice-rectors were women. In the senates and university councils, 39% and 35%, respectively, were women. Presidents, vice presidents, and secretaries of surgical societies and Editor-in-Chief of 4 surgical journals were all men.

CONCLUSIONS

Polish women surgeons face major difficulties with representation in surgery, in departmental, institutional, and societal leadership, and on scientific journal editorial boards. A multifaceted approach to correct these serious inequalities is urgently needed.