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Original Investigation
January 19, 2017

Differences in Clinical Activity and Medicare Payments for Female vs Male Ophthalmologists

Author Affiliations
  • 1Wilmer Eye Institute, The Johns Hopkins University, Baltimore, Maryland
  • 2The University of Texas School of Public Health, Houston
  • 3Mayo Clinic, Rochester, Minnesota
  • 4Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California
  • 5Department of Ophthalmology, Flinders University, Adelaide, South Australia
  • 6Wills Eye Hospital, Philadelphia, Pennsylvania
  • 7Bascom Palmer Eye Institute, Miami, Florida
  • 8Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
JAMA Ophthalmol. Published online January 19, 2017. doi:10.1001/jamaophthalmol.2016.5399
Key Points

Question  How do the earnings and clinical activity of men and women in ophthalmology compare?

Findings  This study of the Centers for Medicare & Medicaid Services database for payments to ophthalmologists in 2012 and 2013 revealed that the average female ophthalmologist collected $0.58 for every dollar collected by a male ophthalmologist; comparing the medians, women collected $0.56 for every dollar earned by men. Women also had lower levels of clinical activity.

Meaning  Women in ophthalmology collect less than men because their clinical activity is lower; an examination of root causes to eliminate obstacles to parity in work effort may be in the best interest of a growing number of practitioners, the patients we serve, and the specialty as a whole.

Abstract

Importance  The number of women in ophthalmology is rising. Little is known about their clinical activity and collections.

Objective  To examine whether charges, as reflected in reimbursements from the Centers for Medicare & Medicaid Services (CMS) to ophthalmologists, differ by sex and how disparity relates to differences in clinical activity.

Design, Setting, and Participants  Retrospective review of the CMS database for payments to ophthalmologists from January 1, 2012, through December 31, 2013. The dates of the analysis were February 1 through May 30, 2016. After exclusion of J and Q codes, the total payments to and the number of charges by individual ophthalmologists were analyzed. The mean values were compared using a single t test, and the medians were compared by the nonparametric Wilcoxon rank sum test.

Main Outcomes and Measures  Primary outcome measures were the mean and median CMS payments to male and female ophthalmologists in outpatient, non–facility-based settings. Secondary outcome measures included the number of charges submitted by men and women and the types of charges most commonly submitted by men and women.

Results  This study included 16 111 ophthalmologists (3078 women [19.1%] and 13 033 men [80.9%]) in 2012 and 16 179 ophthalmologists (3206 women [19.8%] and 12 973 men [80.2%]) in 2013. In 2012, the average female ophthalmologist collected $0.58 (95% CI, $0.54-$0.62; P < .001) for every dollar collected by a male ophthalmologist; comparing the medians, women collected $0.56 (95% CI, $0.50-$0.61; P < .001) for every dollar earned by men. Mean and median collections were similar when comparing female vs male ophthalmologists in 2013 (P < .001). The mean payment per charge was the same for men and women, $66 in 2012 and $64 in 2013. There was a strong association between collections and work product, with female ophthalmologists submitting fewer charges to Medicare in 2012 (median, 1120 charges; difference −935; 95% CI, −1024 to −846; P < .001) and in 2013 (median, 1141 charges; difference −937; 95% CI, −1026 to −848; P < .001) than male ophthalmologists. When corrected by comparing men and women with similar clinical activity, renumeration was still lower for women. In both years, women were underrepresented among ophthalmologists with the highest collections.

Conclusions and Relevance  Remuneration from the CMS was disparate between male and female ophthalmologists in 2012 and 2013 because of the submission of fewer charges by women. Further studies are necessary to explore root causes for this difference, with equity in opportunity and parity in clinical activity standing to benefit the specialty.

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