Longitudinal changes in women's representation in spine surgery: a 10-year medicare database analysis

While the number of women entering orthopedic and neurosurgery residencies has increased, it remains unclear to what extent female representation has increased in spine surgery. The purpose of this study was to assess longitudinal changes in women's representation among spine surgeons, along with their share of spine procedures.

We evaluated all index spine procedures billed in the Medicare Provider Utilization and Payment Data: Physician and Other Practitioners dataset from 2013 to 2022. Revisions, additional levels, and procedures not billed by a self-identified orthopedic or neurosurgeon were excluded. Longitudinal trends in the number of surgeons billing index spine procedures were assessed, stratified by gender and specialty. Similarly, we also compared trends in the number of overall and unique procedures billed.

In total, 6620 unique surgeons were included, consisting of 6371 men and 249 women. Female representation modestly increased over the study period. However, female surgeons billed for fewer overall and unique spine procedures per year over the study period than men, and there were no significant trends over time. Conversely, while women were underrepresented in the top 25% of surgeons by volume, there were no significant differences in volume or unique CPT codes between men and women in the high-volume cohort.

Our study evaluated longitudinal trends in female representation in spine surgery. We identified increases in the number of female spine surgeons over time, but this did not translate into a significant increase in their share of spine procedures. Our findings may inform future efforts to improve opportunities for women trainees.