Female Surgeons Earn 24% Less than Male Surgeons for Equal Hours Worked

Female surgeons are paid considerably less than male surgeons for equal hours worked, according to the results of a new study published in JAMA Surgery.

“Sex-based income disparities are well documented in medicine and most pronounced in surgery. These disparities are commonly attributed to differences in hours worked,” the study authors wrote. “One proposed solution to close the earnings gap is a fee-for-service payment system, which is theoretically free of bias. However, it is unclear whether a sex-based earnings gap persists in a fee-for-service system when earnings are measured on the basis of hours worked.”

In this cross-sectional, population-based study, researchers combed administrative databases from a fee-for-service, single-payer health system in Ontario, Canada. They searched for surgical procedure claims submitted by surgeons between January 2014 and December 2016 and identified 1,508,471 surgical procedures claimed by 3,275 surgeons. The key endpoint in this study was specified as earnings per hour spent between male and female surgeons, respectively, classified by surgical specialty. The researchers assessed different factors potentially contributing to the pay disparity, including differences in procedure duration and type between male and female surgeons, as well as hourly pay for procedures performed on male vs female patients. Subsequently, they analyzed data between February 2018 and December 2018.

A Troubling Disparity

According to the results of the study, female surgeons had practiced fewer years than male surgeons (median [interquartile range], 8.4 [2.9 to 16.6] vs 14.7 [5.9 to 25.7] years; P < .001), and the largest proportion of female surgeons practiced gynecology (400 of 819 female surgeons, 48.8%). The findings showed that the hourly earnings for female surgeons were 24% lower than for male surgeons (relative rate, 0.76 [95% CI, 0.74 to 0.79]; P < .001). The researchers observed that this pay disparity persisted even after adjusting for specialty and in matched analysis classified by specialty, with the largest average differences found in cardiothoracic surgery (in US dollars: $59.64/hour) and orthopedic surgery ($55.45/hour). Moreover, the study observed no differences in time taken to perform common procedures by females juxtaposed to males.

“Even within a fee-for-service system, male and female surgeons do not have equal earnings for equal hours spent working, suggesting that the opportunity to perform the most lucrative surgical procedures is greater for men than women,” the authors wrote in their conclusion.

“These findings call for a comprehensive analysis of drivers of sex-based earning disparities, including referral patterns, and highlight the need for systems-level solutions.”