Gender Differences in Medicare Practice and Payment of Neuroradiologists

Female neuroradiologists in clinical practice are outnumbered by their male counterparts. However, it is unknown whether there are differences in practice patterns and Medicare billing and payment between female and male neuroradiologists. Our aim was to compare representation, practice range, clinical productivity, and Medicare payments for female and male neuroradiologists.

A retrospective cross-sectional study of Medicare provider and service data was conducted. Male and female neuroradiologists who received Medicare payments from 2017 to 2021 and the services rendered were analyzed. Primary outcome was gender representation, mean payments received from Medicare, charges submitted, and codes billed. T tests and Mann-Whitney U tests were used to determine differences in payment and practice volume between male and female radiologists.

From 2017 to 2021, there were a total of 2701 neuroradiologists, of whom 526 (19.5%) were female, with a higher proportion of women in academic than nonacademic neuroradiology practice (23.3% versus 15.6%, respectively). On average, female neuroradiologists charged less (mean, standard error [SE], $642,489 [$14,756] versus $738,416 [$7800]; P < .001) and were paid less by Medicare (mean [SE], $92,834 [$1877] versus $113,495 [$1044]; P < .001) compared with their male counterparts. By contrast, female neuroradiologists had a higher payment-per-service ratio (mean [SE], 0.232 [0.001] versus 0.208 [0.0003]; P < .001). Women billed fewer median total services (1802; interquartile range [IQR], 925-4726] versus 2461 [IQR, 1268-5781]; P < .001), served fewer median beneficiaries (1232 [IQR, 705-1963] versus 1697 [IQR, 990-2682]; P < .001), and billed fewer median unique codes (19 [IQR, 13-26] versus 23 [IQR, 17-33]; P < .001). Temporal analysis of data across the 5-year study period showed that men consistently received higher payments than women, though the difference in mean Medicare charge (P = .03), mean Medicare payment (P = .04), and median number of services provided (P = .04) between the 2 cohorts is decreasing.

Female neuroradiologists were underrepresented, charged less, and received less overall payment compared with their male counterparts. Female neuroradiologists provided a smaller range and number of services, and a greater proportion of female neuroradiologists billed for higher-paying services. Further studies are needed to assess differences in part-time work and subspecialty representation to determine their impact.