Department of Radiation Oncology, University of California, Los Angeles.
David Geffen School of Medicine, Los Angeles, California.
JAMA Netw Open. 2019 Mar 1;2(3):e190932. doi: 10.1001/jamanetworkopen.2019.0932.
Although physician sex is known to influence salary even after controlling for productivity, sex-based differences in clinical activity and reimbursement among radiation oncologists are poorly understood.
To evaluate differences by sex in productivity, breadth of practice, and payments and to characterize Medicare reimbursement by sex among similarly productive groups of radiation oncologists.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted using the January 1 to December 31, 2016, Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use File (POSPUF) to identify charge and payment information for individual radiation oncologists. Clinicians were part of a population-based sample of US radiation oncologists who bill Medicare in both non-facility-based (NFB) and facility-based (FB) practice settings. Analysis was conducted from June 5 to 25, 2018.
Outcome measurements included physician productivity (measured by number of Medicare charges), physician payments (reported as total Medicare payments as well as mean payments per charge submitted and per beneficiary treated), and physician breadth of practice (measured by number of unique Medicare billing codes) in NFB and FB settings.
A total of 4393 radiation oncologists (1133 women and 3260 men) were included in the POSPUF in 2016. Compared with their male counterparts, female physicians in the NFB setting submitted a mean of 1051 fewer charges (95% CI, -1458 to -644; P < .001), collected a mean of $143 610 less in revenue (95% CI, -$185 528 to -$101 692; P < .001), and used a mean of 1.32 fewer unique billing codes (95% CI, -2.23 to -0.41; P = .004). Compared with their male counterparts, female radiation oncologists in the FB setting submitted a mean of 423 fewer charges (95% CI, -506 to -341; P < .001), collected a mean of $26 735 less in revenue (95% CI, -$31 910 to -$21 560; P < .001), and submitted a mean of 1.28 fewer unique billing codes (95% CI, -1.77 to -0.78; P < .001). Women represented 46 of the 397 most highly productive radiation oncologists in the FB setting (11.6%) and collected a mean of $33 026 less (95% CI, -$52 379 to -$13 673; P = .001) than men who were similarly productive. In the NFB setting, women represented 54 of the 326 most highly productive radiation oncologists (16.6%) and collected $345 944 (95% CI, -$522 663 to -$169 225; P < .001) less than similarly highly productive men. Women collected a mean of $8.49 less per charge (95% CI, -$14.13 to -$2.86; P = .003) than men in the NFB setting.
This study suggests that female radiation oncologists submit fewer Medicare charges, are reimbursed less per charge they submit, and receive lower Medicare payments overall compared with male radiation oncologists. Even among similarly productive radiation oncologists, women in this study still collected less revenue than men. Further research is required to understand the sex-based barriers to economic advancement within radiation oncology.
尽管已知医生的性别会影响薪资，即使在控制了生产力之后，放射肿瘤学家的临床活动和报酬方面的性别差异仍知之甚少。
评估性别差异在生产力、实践广度以及支付方面的差异，并描述类似生产力组的放射肿瘤学家的医疗保险报销情况。
设计、地点和参与者：使用 2016 年 1 月 1 日至 12 月 31 日的医疗保险和医疗补助服务中心医生和其他供应商公共使用文件（POSPUF）进行回顾性队列研究，以确定个体放射肿瘤学家的收费和支付信息。临床医生是美国放射肿瘤学家的基于人群样本的一部分，他们在非设施（NFB）和设施（FB）实践环境中向医疗保险收费。分析于 2018 年 6 月 5 日至 25 日进行。
主要的结果测量包括医生的生产力（通过 Medicare 收费的数量来衡量）、医生的支付（报告为总 Medicare 支付，以及每个提交的收费和每个治疗受益人的平均支付）和医生的实践广度（通过 Medicare 计费代码的数量来衡量）在 NFB 和 FB 设置。
在 2016 年的 POSPUF 中，共有 4393 名放射肿瘤学家（1133 名女性和 3260 名男性）被纳入研究。与男性相比，NFB 环境中的女性医生平均提交的收费少 1051 个（95%置信区间，-1458 至 -644；P<0.001），收入少 143610 美元（95%置信区间，-185528 至 -101692；P<0.001），使用的独特计费代码少 1.32 个（95%置信区间，-2.23 至 -0.41；P=0.004）。与男性相比，FB 环境中的女性放射肿瘤学家平均提交的收费少 423 个（95%置信区间，-506 至 -341；P<0.001），收入少 26735 美元（95%置信区间，-31910 至 -21560；P<0.001），提交的独特计费代码少 1.28 个（95%置信区间，-1.77 至 -0.78；P<0.001）。在 FB 环境中，女性占 397 名最具生产力的放射肿瘤学家中的 46 名（11.6%），收入少 33026 美元（95%置信区间，-52379 至 -13673；P=0.001），比同样具有生产力的男性医生少。在 NFB 环境中，女性占 326 名最具生产力的放射肿瘤学家中的 54 名（16.6%），收入少 345944 美元（95%置信区间，-522663 至 -169225；P<0.001），比同样具有生产力的男性医生少。与 NFB 环境中的男性医生相比，女性医生的平均收费少 8.49 美元（95%置信区间，-14.13 至 -2.86；P=0.003）。
这项研究表明，与男性放射肿瘤学家相比，女性放射肿瘤学家提交的 Medicare 收费较少，每提交一个收费的报酬较低，总体上收到的 Medicare 支付也较少。即使在具有相似生产力的放射肿瘤学家中，这项研究中的女性医生的收入仍然低于男性。需要进一步研究以了解放射肿瘤学中经济进步的性别障碍。
