Quick Take: Sex-Based Disparities in the Hourly Earnings of Surgeons in the Fee-for-Service System in Ontario, Canada

1. Female surgeons earn less in a fee-for-service system than their male counterparts despite a lack of differences in hours worked or procedure duration, with the greatest discrepancies found in orthopedic surgery and cardiothoracic surgery.

Evidence Rating Level: 2 (Good)

Ample medical literature supports sex-based disparities in income across specialties, with surgical specialties demonstrating markedly different earnings between males and females. This cross-sectional, population-based study analyzed administrative databases of the fee-for-service, single payer system in Ontario, Canada to assess earning differences between surgeon sex. Included factors related to the primary outcome were differences in procedure duration, procedure type, as well as earning differences for procedures performed predominantly on males or females. A total of 3,275 surgeons claimed 1,508,471 surgical procedures.  The median number of year practiced was greater in males (p<0.001). There were also a large proportion of total female surgeons practicing gynecology (48.8%). No differences between female and male surgeons were found in procedure duration, though female surgeons were more likely to perform lower-earning procedures. Hourly earnings for females were 24% lower than their male counterparts (RR 0.76, CI 0.74 to 0.79, p<0.001). Significance persisted following adjustment for specialty as well as in matched analysis stratified by specialty. The largest earning differences were found within orthopedic surgery (difference $55.45 per hour USD; $73.90 per hour Canadian) and cardiothoracic surgery (difference $59.64 per hour USD; $79.49 per hour Canadian). This study demonstrates notable sex-based disparities in earnings within a fee-for-service system, despite equal hours spent conducting procedures. These findings warrant a thorough evaluation of current practices in Canadian healthcare as they relate to sex-based earnings, including obstacles faced by female surgeons and any systemic bias related to referrals.

Click to read the study in JAMA Surgery

Image: PD

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