Why Women Doctors Make Half of What Men Do: Medicare’s Doctor Gender Pay Gap

Female doctors are pulling in only about half as much money as their male counterparts in the Medicare system — the nation’s largest insurer — according to a new study by NerdWallet Health.While Medicare pays both men and women equally for providing the same service, several factors may contribute to women earning much less over the course of a year. This study shows how the gender pay gap is affecting the nation’s more than 800,000 physicians.

Key findings
On average, male doctors are paid 88% more in annual Medicare reimbursements. Men make $118,782 per year from Medicare; women are paid $63,346. While Medicare reimbursement is only one component of physician salary, our study found:

• Male physicians see 60% more patients. On average, women doctors treat 320 Medicare patients a year, while men treat 513.
• Male doctors make more money per patient treated. On average, they make 24% more treating each patient than female doctors do.
• Male doctors perform more services per patient treated. To explore this, NerdWallet Health devised a metric to calculate a physician’s average “service volume” per patient. We found that male doctors billed Medicare, on average, for one more procedure per patient than female physicians (5.7 services performed per patient by male doctors vs. 4.7 services per patient by female doctors).
• This gap in service volume is true across specialties. Male doctors performed more services per patient than female doctors across nearly all specialties. In a specialty like pathology – where doctors infrequently provide services directly to patients – we found no variation in average service volume.

NerdWallet Health research highlights inconsistencies in the way medicine is practiced by American doctors. It does not show that one gender practices better medicine or provides higher quality care than the other. Prior research has shown that male doctors generally work more hours, which could increase their billings to Medicare. Men also dominate high-paying surgical fields; women make up less than 10% of Medicare physicians in surgical specialties like cardiac, orthopedic, and neurosurgery.

Still, this new NerdWallet research points to a larger issue with Medicare. Because Medicare pays through a fee-for-service system, doctors have a financial incentive to provide more services. More services means patients incur additional costs. These costs are both financial, in the form of additional copayments, as well as medical, in the form of increased exposure to a health care system in which over 210,000 patients die annually from medical errors.

While this study suggests that practice variation exists between men and women physicians, there are other important factors that may impact this gender pay gap. These influences include:

• Geography: Medicare payments vary by location. If female physicians are congregated in lower paying ZIP codes, this could contribute to the discrepancy.
• Coding variations: Medicare payments vary by the type of service provided. Men may be performing more highly reimbursed procedures than their female counterparts are.
• Care setting: Medicare typically pays less to physicians when procedures are performed in a hospital setting rather than in a clinic. If women are more likely to be hospital-based, that may be why they are receiving less reimbursement from Medicare–even within specialties.
• Missing data: Due to privacy concerns, Medicare withheld data when less than 11 patients were treated by an individual doctor for a given procedure code. It is possible that women physicians are more likely to have procedures or patient volumes that fall into this low range.

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