Reddy Ashvini K, Bounds Gregory W, Bakri Sophie J, Gordon Lynn K, Smith Justine R, Haller Julia A, Berrocal Audina M, Thorne Jennifer E
Wilmer Eye Institute, The Johns Hopkins University, Baltimore, Maryland.
The University of Texas School of Public Health, Houston.
JAMA Ophthalmol. 2017 Mar 1;135(3):205-213. doi: 10.1001/jamaophthalmol.2016.5399.
The number of women in ophthalmology is rising. Little is known about their clinical activity and collections.
To examine whether charges, as reflected in reimbursements from the Centers for Medicare & Medicaid Services (CMS) to ophthalmologists, differ by sex and how disparity relates to differences in clinical activity.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of the CMS database for payments to ophthalmologists from January 1, 2012, through December 31, 2013. The dates of the analysis were February 1 through May 30, 2016. After exclusion of J and Q codes, the total payments to and the number of charges by individual ophthalmologists were analyzed. The mean values were compared using a single t test, and the medians were compared by the nonparametric Wilcoxon rank sum test.
Primary outcome measures were the mean and median CMS payments to male and female ophthalmologists in outpatient, non-facility-based settings. Secondary outcome measures included the number of charges submitted by men and women and the types of charges most commonly submitted by men and women.
This study included 16 111 ophthalmologists (3078 women [19.1%] and 13 033 men [80.9%]) in 2012 and 16 179 ophthalmologists (3206 women [19.8%] and 12 973 men [80.2%]) in 2013. In 2012, the average female ophthalmologist collected $0.58 (95% CI, $0.54-$0.62; P < .001) for every dollar collected by a male ophthalmologist; comparing the medians, women collected $0.56 (95% CI, $0.50-$0.61; P < .001) for every dollar earned by men. Mean and median collections were similar when comparing female vs male ophthalmologists in 2013 (P < .001). The mean payment per charge was the same for men and women, $66 in 2012 and $64 in 2013. There was a strong association between collections and work product, with female ophthalmologists submitting fewer charges to Medicare in 2012 (median, 1120 charges; difference -935; 95% CI, -1024 to -846; P < .001) and in 2013 (median, 1141 charges; difference -937; 95% CI, -1026 to -848; P < .001) than male ophthalmologists. When corrected by comparing men and women with similar clinical activity, renumeration was still lower for women. In both years, women were underrepresented among ophthalmologists with the highest collections.
Remuneration from the CMS was disparate between male and female ophthalmologists in 2012 and 2013 because of the submission of fewer charges by women. Further studies are necessary to explore root causes for this difference, with equity in opportunity and parity in clinical activity standing to benefit the specialty.
眼科领域的女性人数正在增加。关于她们的临床活动和收入情况，人们了解甚少。
研究医疗保险和医疗补助服务中心（CMS）向眼科医生支付的费用是否因性别而异，以及这种差异与临床活动差异之间的关系。
设计、地点和参与者：对2012年1月1日至2013年12月31日期间CMS向眼科医生支付费用的数据库进行回顾性分析。分析日期为2016年2月1日至5月30日。排除J和Q代码后，对每位眼科医生的总支付金额和收费数量进行分析。使用单样本t检验比较均值，通过非参数Wilcoxon秩和检验比较中位数。
主要结局指标是CMS在门诊非机构环境中向男性和女性眼科医生支付的平均和中位数费用。次要结局指标包括男性和女性提交的收费数量以及男性和女性最常提交的收费类型。
本研究纳入了2012年的16111名眼科医生（3078名女性[19.1%]和13033名男性[80.9%]）以及2013年的16179名眼科医生（3206名女性[19.8%]和12973名男性[80.2%]）。2012年，女性眼科医生每获得1美元，男性眼科医生平均获得0.58美元（95%CI，0.54 - 0.62美元；P <.001）；比较中位数，女性每获得1美元，男性获得0.56美元（95%CI，0.50 - 0.61美元；P <.001）。2013年比较女性和男性眼科医生时，平均和中位数收入相似（P <.001）。2012年男性和女性每次收费的平均支付金额相同，均为66美元，2013年为64美元。收入与工作量之间存在很强的关联，2012年女性眼科医生向医疗保险提交的收费较少（中位数为1120次收费；差异为 - 935；95%CI， - 1024至 - 846；P <.001），2013年也是如此（中位数为1141次收费；差异为 - 937；95%CI， - 1026至 - 848；P <.001）。在比较临床活动相似的男性和女性时进行校正后，女性的薪酬仍然较低。在这两年中，收入最高的眼科医生中女性所占比例都较低。
2012年和2013年，CMS支付给男性和女性眼科医生的薪酬存在差异，原因是女性提交的收费较少。有必要进一步研究这种差异的根本原因，机会均等和临床活动平等将有利于该专业领域。
