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Doctor-set procedure values keep gynecologic surgery paid below comparable operations on men
Surgeons earned about 44 percent more for male-specific procedures than female analogues in a 1997 study, a gap that has barely narrowed in 20 years. A doctor-run committee sets those values, so hospitals receive the gap as a price signal that pulls resources away from gynecology.
The Board Room · Leadership desk
What happened
- A committee of doctors largely sets each procedure's value, using surveys in which physicians self-report the time and skill their own procedures take.
- Federal rates are built on relative value units, and Medicare and private insurers both consult those figures when they settle reimbursement.
- Bioethicist Katie Watson calls the pattern "double discrimination": lower pay in a mostly female specialty that mainly treats women.
- A maternity billing overhaul that splits prenatal, delivery and postpartum services takes effect early next year and leaves gynecologic surgery out.
Compiled by The Board RoomSomething wrong?How this is made
Why it matters
- constraint Because the gap is set in the procedure's value, a gynecologic surgeon who negotiates a better salary is still billing codes priced below comparable male procedures.
- cost Hospitals that earn less per gynecologic case have reason to put fewer resources into women's services, so patients get worse care and trainees get fewer cases.
- decision With maternity codes being rebuilt now, specialty societies must choose whether to press for gynecologic revaluation in this cycle or leave it for a later review.
Much of the pay gap that survives controls for specialty, rank and age [1] is set in the billing record: a gynecologic procedure's payment rate is fixed before any salary negotiation. Vox reports that female-specific procedures are still largely reimbursed at lower rates than male-specific ones, even when they take similar time and skill [13].
The way values are set helps explain why the gap holds. Physicians report the time and skill their own procedures require, and Vox describes those surveys as sometimes inaccurate [6]. Codes do get revised, but revision follows pressure: procedures are reevaluated, and medical societies and experts push for changes [10]. Gynecologic surgery is overwhelmingly female, and most of its patients are women [3].
Dr. Barbara Goff, now chair of obstetrics and gynecology at UW Medicine, and colleagues measured the gap in a 1997 Gynecologic Oncology paper titled "Is Adam worth more than Eve?" [7][14]. Their 44 percent figure means a female-specific procedure paid about 69 cents for each dollar paid on its male counterpart [1]. Vox's reporting does not include a current percentage to compare with it.
Katie Watson, a bioethics professor, coined "double discrimination" in a 2021 conversation with Dr. Louise King, a gynecologic surgeon, and the term has since entered the medical literature [4][15]. It describes two layers. Female surgeons are underpaid relative to male peers after controls [1]. Gynecologic surgeons, who are mostly women, also perform procedures valued below comparable surgeries on men [2][3]. The second layer is built into the procedure's value, so a salary negotiation leaves it untouched [6].
A hospital finance chief could fairly say that a federal agency and a committee of doctors set these values, and she does not [8][6]. She does decide where the money goes. Vox reports that hospitals allocate fewer resources to services that pay less for treating women. It says the results are worse outcomes for women and fewer training opportunities for the surgeons who perform these procedures [9].
The decisions on this quarter's budget and on this decade's prices are separate. Vox reports that repricing will take concerted effort, and that the gap could be closed by revaluing gynecologic surgeries and removing sex-specific billing codes [16][12]. The maternity billing overhaul due early next year shows that codes can change, but it covers obstetrics only [11]. In my view, a hospital that trims gynecologic capacity this year because those cases pay less is also cutting the training cases its future gynecologic surgeons would get [9].
What to watch
- Whether CMS or the doctor-run valuation committee opens a review of gynecologic surgical codes once the maternity billing overhaul takes effect early next year.
- Any formal proposal to remove sex-specific billing codes, one of the two fixes Vox's reporting identifies.
- An updated study of the female-to-male procedure payment gap that can be set against the 1997 figure of 44 percent.