Bridging the Gender Pay Gap: Medicare Procedure Volume and Reimbursement Among Spine Surgeons

Gender differences in physician compensation have been described in various medical specialties, although little is known about reimbursement patterns among spine surgeons. We sought to determine whether any differences exist in procedural volume, claims, and Medicare reimbursement between male and female spine surgeons performing fusion procedures.

This was a retrospective analysis of the Medicare Provider Utilization and Payment Public Use File (2017-2022). Spine surgeons performing fusion procedures were identified and stratified by sex. Procedural volume, claims, and reimbursement across fusion categories were collected. Multivariable log-linear regression models adjusted for procedural volume and year effects were constructed. Nonparametric bootstrap resampling (5,000 iterations) and propensity score overlap weighting were included as sensitivity analyses.

A total of 2,311 spine surgeons were identified, of whom 34 (1.5%) were female. Male and female surgeons performed comparable numbers of total fusions (10.44 ± 7.79 vs 7.97 ± 7.18; P = .0625). However, male surgeons received significantly greater Medicare and surgical reimbursement. Adjusted regression analyses demonstrated that female surgeons were independently associated with 21% lower fusion-related reimbursement (P = .028) and 30% lower Medicare reimbursement (P = .004). The findings' directionality was confirmed via bootstrap and propensity-weighted sensitivity analyses.

Between 2017-2022, male spine surgeons had higher total Medicare reimbursements and per-procedure reimbursements for lower and posterior spinal fusions, despite similar procedural volumes among surgeons. These differences remained even after statistical adjustment for procedural volume and calendar year. Future work incorporating additional clinical- and practice-level variables may clarify drivers of these differences.