Departments of Medical Social Science, Medical Education, and Obstetrics & Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Reproductive Bioethics, Center for Bioethics, Harvard Medical School, Boston, Massachusetts.
Obstet Gynecol. 2021 Apr 1;137(4):657-661. doi: 10.1097/AOG.0000000000004309.
In this commentary, we describe historical and other influences that drive "double discrimination" in gynecologic surgery-lower pay in the area of surgery that boasts the largest proportion of female surgeons and is focused on female patients and explore how it results in potentially lower quality care. Insurers reimburse procedures for women at a lower rate than similar procedures for men, although there is no medically justifiable reason for this disparity. The wage gap created by lower reimbursement rates disproportionately affects female surgeons, who are disproportionately represented among gynecologic surgeons. This contributes to a large wage gap in surgery for women. Finally, poor reimbursement for gynecologic surgery pushes many obstetrics and gynecology surgeons to preferentially perform obstetric services, resulting in a high prevalence of low-volume gynecologic surgeons, a metric that is closely tied to higher complication rates. Creating equity in reimbursement for gynecologic surgery is one important and ethically required step forward to gender equity in medicine for patients and surgeons.
在这篇评论中，我们描述了推动妇科手术中“双重歧视”的历史和其他影响——在外科领域，该领域拥有最多女性外科医生，专注于女性患者，但薪酬却较低，并探讨了这种情况如何导致潜在的护理质量下降。尽管没有医学上合理的理由来解释这种差异，但保险公司对女性手术的报销率低于对男性手术的报销率。较低的报销率造成的工资差距不成比例地影响了女性外科医生，而女性外科医生在妇科外科医生中所占比例过高。这导致了女性手术中存在巨大的工资差距。最后，妇科手术的低报销率促使许多妇产科医生优先提供产科服务，导致大量低容量的妇科外科医生，这一指标与更高的并发症率密切相关。为妇科手术的报销创造公平性是朝着患者和外科医生的医学性别平等迈出的重要且在伦理上必要的一步。
