Dr. Christina Brady’s research article published in JBJS volume 100 issue 4 on February 21, 2018


Background: The observed sex gap in physician salary has been the topic of much recent debate in the United States, but it has not been well-described among orthopaedic surgeons. The objective of this study was to evaluate for sex differences in Medicare claim volume and reimbursement among orthopaedic surgeons.

Methods: The Medicare Provider Utilization and Payment Public Use File was used to compare claim volume and reimbursement between female and male orthopaedic surgeons in 2013. Data were extracted for each billing code per orthopaedic surgeon in the year 2013 for total claims, surgical claims, total knee arthroplasty (TKA) claims, and total hip arthroplasty (THA) claims.

Results: A total of 20,546 orthopaedic surgeons who treated traditional Medicare patients were included in the initial analysis. Claim volume and reimbursement received were approximately twofold higher for all claims and more than threefold higher for surgical claims for male surgeons when compared with female surgeons (p < 0.001 for all comparisons). A total of 7,013 and 3,839 surgeons performed >10 TKAs and THAs, respectively, in 2013 for Medicare patients and were included in the subset analyses. Although male surgeons performed a higher mean number of TKAs than female surgeons (mean and standard deviation, 37 ± 33 compared with 26 ± 17, respectively, p < 0.001), the claim volume for THAs was similar (29 ± 22 compared with 24 ± 13, respectively, p = 0.080). However, there was no significant difference in mean reimbursement payments received per surgeon between men and women for TKA or THA ($1,135 ± $228 compared with $1,137 ± $184 for TKA, respectively, p = 0.380; $1,049 ± $226 compared with $1,043 ± $266 for THA, respectively, p = 0.310).

Conclusions: Female surgeons had a lower number of total claims and reimbursements compared with male surgeons. However, among surgeons who performed >10 THAs and TKAs, there were no sex differences in the mean reimbursement payment per surgeon.

Clinical Relevance: The number of women in orthopaedics is rising, and there is much interest in how their productivity and compensation compare with their male counterparts.

1Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

2Department of Orthopaedic Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, Texas

3Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas

Copyright 2018 by The Journal of Bone and Joint Surgery, Incorporated