Gender disparities in payment among orthopedic surgeons: An analysis of medicare provider utilization and payment data

Background: This study aimed to determine if the disparity in pay described between male and female orthopedic surgeons extends to a payment per service model. Methods: Public data from the Centers for Medicare & Medicaid Services was accessed for orthopedic surgeons from 2019-2020. Credentials were documented from public websites. The number of services provided and payment amounts were compared across states, and between genders of provider. Multivariable linear regression models were used to determine predictors of total payments. Results: Women make up 5.88% orthopedic surgeons through CMS. Male providers had a higher average number of HCPCS codes, Medicare patients, total submitted charges, and total payment amounts. The total Medicare payment and total drug Medicare payment were significantly higher for male providers. However, when adjusted for payment per service, there was no significant difference between genders. Additional graduate degrees, and the state, and RUCA code of the provider's practice were significant predictors of amount paid per service; having a Doctor of Medicine versus any other medical degree was not. There was no significant difference in payment per service between male and female orthopedic surgeons. Nevertheless, major gender disparities exist for women in orthopedic surgery impacting their income when compared to their male counterparts. Conclusion: The problem of the gendered wage gap in orthopedics does not lie with payment per-service compensation protocols themselves, but in other factors that affect female orthopedic surgeons' ability to provide services. These findings support a call for pay transparency and objective criteria to inform and modify salaries.