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Original Investigation
July 30, 2020

Assessment of Gender Differences in Clinical Productivity and Medicare Payments Among Otolaryngologists in 2017

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear, Boston
  • 2Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
  • 3Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
  • 4Harvard Business School, Boston, Massachusetts
  • 5Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts
  • 6Patient-Reported Outcomes, Value and Experience (PROVE) Center, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Otolaryngol Head Neck Surg. 2020;146(9):1-10. doi:10.1001/jamaoto.2020.1928
Key Points

Question  Do physician productivity, diversity of practice, and Medicare payments differ between male and female otolaryngologists?

Findings  In this cross-sectional study of publicly available Medicare data for 8456 otolaryngologists who received Medicare payments in 2017, female otolaryngologists billed for fewer unique codes (ie, had decreased diversity of practice), provided a lower number of services (ie, had lower productivity), and received less payment from Medicare than male otolaryngologists. When stratified by levels of clinical productivity, highly productive women collected less Medicare payment than highly productive men; gender-based disparities were more pronounced in the non–facility-based setting (eg, physician office) compared with the facility-based (ie, hospital) setting.

Meaning  Female sex is associated with decreased diversity of practice, lower clinical productivity, and decreased Medicare payment in the field of otolaryngology; further efforts are necessary to identify and address potential causes of disparity within the specialty.


Importance  Women comprise an increasing proportion of the otolaryngology workforce. Prior studies have demonstrated gender-based disparity in physician practice and income in other clinical specialties; however, research has not comprehensively examined whether gender-based income disparities exist within the field of otolaryngology.

Objective  To determine whether diversity of practice, clinical productivity, and Medicare payment differ between male and female otolaryngologists and whether any identified variation is associated with practice setting.

Design, Setting, and Participants  Retrospective cross-sectional analysis of publicly available Medicare data summarizing payments to otolaryngologists from January 1 through December 31, 2017. Male and female otolaryngologists participating in Medicare in facility-based (FB; hospital-based) and non–facility-based settings (NFB; eg, physician office) for outpatient otolaryngologic care were included.

Main Outcomes and Measures  Number of unique billing codes (diversity of practice) per physician, number of services provided per physician (physician productivity), and Medicare payment per physician. Outcomes were stratified by practice setting (FB vs NFB).

Results  A total of 8456 otolaryngologists (1289 [15.2%] women; 7167 [84.8%] men) received Medicare payments in 2017. Per physician, women billed fewer unique codes (mean difference, −2.10; 95% CI, −2.46 to −1.75; P < .001), provided fewer services (mean difference, −640; 95% CI, −784 to −496; P < .001), and received less Medicare payment than men (mean difference, −$30 246 (95% CI, −$35 738 to −$24 756; P < .001). When stratified by practice setting, women in NFB settings billed 1.65 fewer unique codes (95% CI, −2.01 to −1.29; P < .001) and provided 633 fewer services (95% CI, −791 to −475; P < .001). In contrast, there was no significant gender-based difference in number of unique codes billed (mean difference, 0.04; 95% CI, −0.217 to 0.347; P = .81) or number of services provided (mean difference, 5.1; 95% CI, −55.8 to 45.6; P = .85) in the FB setting. Women received less Medicare payment in both settings compared with men (NFB: mean difference, −$27 746; 95% CI, −$33 502 to −$21 989; P < .001; vs FB: mean difference, −$4002; 95% CI, −$7393 to −$612; P = .02), although the absolute difference was lower in the FB setting.

Conclusions and Relevance  Female sex is associated with decreased diversity of practice, lower clinical productivity, and decreased Medicare payment among otolaryngologists. Gender-based inequity is more pronounced in NFB settings compared with FB settings. Further efforts are necessary to better evaluate and address gender disparities within otolaryngology.

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