{"id":868351,"date":"2026-10-02T14:52:13","date_gmt":"2026-10-02T14:52:13","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/868351\/"},"modified":"2026-10-02T14:52:13","modified_gmt":"2026-10-02T14:52:13","slug":"why-are-doctors-paid-less-for-procedures-on-women","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/868351\/","title":{"rendered":"Why are doctors paid less for procedures on women?"},"content":{"rendered":"

In the moody alcoves of a lobby bar in Chicago in 2021 over French 75s, Dr. Louise King, a gynecologic surgeon, and Katie L. Watson, a bioethics professor, found themselves in conversation about a topic that had long frustrated them both: Female surgeons are consistently underpaid<\/a> compared to male surgeons, even after accounting for specialty, rank, age, and other factors.<\/p>\n

What troubled them even more was how the pay gap compounded in King\u2019s own field. Surgeons who perform procedures that are specifically for women, like gynecological surgeries, are paid less for their services than surgeons who perform comparable surgeries for the male anatomy. Gynecologic surgeons are also predominantly women<\/a>. Over the course of the conversation, Watson termed this situation \u201cdouble discrimination,\u201d a phrase that captures the overlapping dilemma of lower pay for surgeries in a specialty that is overwhelmingly female and also serves a primarily female patient population.<\/p>\n

Doctors are paid less for gynecologic surgeries than for similar surgeries on men. That pay gap has barely improved in the last 20 years.The value of each procedure is largely set by a committee of doctors that relies on self-reported, and sometimes inaccurate, surveys in which doctors report the skill and time their own procedures require.When doctors are paid less to treat women\u2019s health concerns, hospitals allocate fewer resources to those services, leading to worse outcomes for women Experts say the gap can be closed by reconsidering how gynecologic surgeries are valued and removing sex-specific billing codes.<\/p>\n

That term, which has since entered the medical literature<\/a>, stuck because the problem it describes has been well documented for decades. In 1997, a group of gynecologic surgeons published a paper in the journal Gynecologic Oncology with a title that gets straight to it \u2014 \u201cIs Adam worth more than Eve<\/a>?\u201d Dr. Barbara A. Goff, now chair of Obstetrics and Gynecology at University of Washington Medicine, and colleagues found that doctors are paid around 44 percent more for performing male-specific procedures than analogous female-specific ones.<\/p>\n

In the three decades since, the problem hasn\u2019t been fixed. To the contrary, it has been effectively institutionalized, built into the systems and codes that determine how surgeons bill for procedures of all kinds. Today, gynecologic or female-specific procedures are in large parts still reimbursed at lower rates than male-specific procedures even when they take similar time and skill.<\/p>\n

Those disparities have consequences that extend beyond the compensation of individual doctors. When gynecological procedures don\u2019t bring in as much money to hospitals, those same hospitals are disincentivised to offer women\u2019s health services. That can lead to worse care for women and, crucially, fewer training opportunities for the surgeons who do that work.<\/p>\n

But this historically persistent inequality is not a foregone conclusion.<\/p>\n

How healthcare services are billed changes all the time as procedures get reevaluated, new ones get added, and medical societies and experts push for revisions. In fact, one of the biggest changes in how maternity care is billed and reimbursed is set to take effect early next year<\/a>, splitting up services for prenatal care, delivery, postpartum care, and more. While this is a long-overdue fix for obstetrics, gynecologic surgery \u2014 which covers most of a woman\u2019s life outside of childbearing years \u2014 continues to be left out of the conversation.<\/p>\n

And although real change will require concerted efforts, King and Watson \u2014 and other advocates who have spent years documenting this disparity \u2014 have a fairly clear sense of how to start fixing it.<\/p>\n

How surgical procedures are valued<\/p>\n

The work of deciding how much a medical procedure is worth starts well above the head of any given doctor, medical practice, or hospital. In the United States, the Centers for Medicare and Medicaid Services, a federal agency that administers healthcare and health insurance policies, sets rates for different procedures based on a metric called relative value units (RVUs). An RVU is supposed to take into account how long a procedure takes, the skill it requires, and the intensity of work it demands. Both Medicare and private insurers consider these figures when they\u2019re settling on reimbursement levels. If a procedure has a higher RVU, it is valued more highly, and makes more money.<\/p>\n

In a recent study, cheekily titled \u201cPrice and Prejudice<\/a>,\u201d researchers from the Mount Sinai Health System found that out of 55 pairs of sex-specific procedures that they evaluated in 2023, 75 percent had lower RVUs for procedures on female patients. On average, RVUs for male-specific procedures were 30 percent higher, and when those procedures were performed in a hospital or surgical center, surgeons were paid around 26 percent more.<\/p>\n

For example, doctors will often perform biopsies \u2014 taking a small sample of tissues, cells, or fluids \u2014 on both male and female genitalia to diagnose problems. In 2023, researchers found that Medicare\u2019s standard national rate for reimbursing surgeons was $121.32 for a penile biopsy but only $65.74 for a vaginal biopsy.<\/p>\n

Loading interactive graphic\u2026<\/p>\n

King, the director of reproductive bioethics at Harvard Medical School Center for Bioethics and a contributor on the study, believes that when the RVU system was created back in the 1990s, gynecological services were largely ignored, leaving the specialty undervalued from the start. While Medicare and Medicaid Services has undertaken some efforts to make RVUs more equitable across specialties over the years, that undervaluation has persisted.<\/p>\n

That problem may come down to how those values are determined in the first place \u2014 and who determines them. RVUs are set by a committee of doctors<\/a> convened by the American Medical Association (AMA), with most of the seats allocated to members of major medical societies. The committee surveys different doctors on the time and skill required for procedures in their specialties. Based on these responses, the committee recommends values for each service to the federal government, which has historically accepted nearly 90 percent of them<\/a>.<\/p>\n

While the data quality of the underlying surveys has improved over the years, it is still not very high, said Dr. Miriam Laugesen, a tenured associate professor of health policy and management at Columbia University Mailman School of Public Health. Because the committee\u2019s process isn\u2019t transparent, it is often unclear what evidence its valuations rest on. This leads to distortions of all kinds, she said.<\/p>\n

\u201dIt\u2019s not a government process; It\u2019s not a federal advisory committee,\u201d Laugesen said. \u201cIt\u2019s just a committee that was put together by the [AMA]. It\u2019s pretty unusual in terms of how policy is made.\u201d<\/p>\n

In particular, King said that the surveys have a very low response rate from some specialties and are only sent to a small subset of doctors. She has never received a committee survey in the 17 years that she has practiced.<\/p>\n

The American College of Obstetricians and Gynecologists (ACOG) has a core seat on the committee that determines RVUs. But most ACOG members are general OB-GYNs, who split their time between obstetrics and gynecology and typically operate relatively rarely. The surgeons who perform the bulk of gynecologic operations are subspecialists \u2013 gynecologic oncologists, urogynecologists, and minimally invasive gynecologic surgeons \u2014 who complete an additional fellowship after residency. They mainly belong to their own societies and don\u2019t have a seat at the table when RVUs are being determined.<\/p>\n

\u201dFrom a purely cynical or economic standpoint, [ACOG] has no reason to advance billing for gynecology. It doesn\u2019t represent a large portion of the practices of their members,\u201d said King, adding that ACOG has been heroic in its efforts to obtain reimbursement equity for its own members. (One unintended possible result of that advocacy is that pushing for a smaller pay gap for services related to pregnancy, has in turn sent the message that women\u2019s bodies are literally worth less, and are less deserving of care when they\u2019re not engaged in the god-given duty of reproduction.)<\/p>\n

The result is that doctors in specialties like OB-GYN who operate infrequently are answering the surveys about complicated surgical procedures that gynecologic surgeons perform more frequently. King said that her surgical schedule aligned more closely with those of general surgeons. For example, she operates two to three times a week whereas, according to her, an average OB-GYN will likely operate once a month.<\/p>\n

\u201cSo they\u2019re not the right people to be answering these surveys. They [the survey committee and ACOG] don\u2019t target the surveys to people who operate a lot,\u201d she said.<\/p>\n

Part of the problem with using surveys to determine a key foundation of medical reimbursements is that the data is self-reported by doctors. This is especially relevant when more objective avenues may be available. One of those avenues is the American College of Surgeons\u2019 National Surgical Quality Improvement Program, which is an initiative that collects and manages key surgical data to track quality and improvement in surgical fields, including the actual time spent performing surgical procedures, making it a more definitive measure than self-reported surveys.<\/p>\n

Dr. Shitanshu Uppal, a gynecologic oncologist and division chief for gynecology oncology service at the University of Michigan, and his colleagues analyzed 901,917 surgeries<\/a> using both the National Surgical Quality Improvement Program as well as the self-reported surveys used to determine RVUs. They found that median RVUs per hour vary widely between specialties. Gynecology had the third-lowest median RVUs per hour of all the specialties studied. In effect, that means that gynecological surgeons are paid less for every hour that they work.<\/p>\n

The researchers also found that compared to the operating times logged for real surgeries in the Surgical Quality Improvement Program, surgeons in certain specialties tended to report longer procedure times in the self-reported surveys sent out by the RVUs committee. Specialties that reported longer operating times were more likely to be awarded higher RVUs, leading to greater hourly rates of reimbursement.<\/p>\n

According to Uppal\u2019s analysis, urologists \u2014 a profession most often associated with procedures on men because their work routinely concerns the prostate and the testicles \u2014 reported times that exceeded the baseline data by a median of 20 minutes. By contrast, estimates from gynecologists only exceeded the actual time by a median of five minutes, meaning that urologists tended to overestimate their time spent in surgery by four times as many minutes. Generally, urologists earn much more than general OB-GYNs, who in turn earn more than other subspecialties like gynecologic surgery. Despite having access to reliable electronic records of operating time, Uppal and his colleagues note, the AMA committee still continues to use self-reported operating times, which influences their RVU recommendations, ultimately cementing disparities in female-specific procedures.<\/p>\n

\u201cThe system that they have now developed over time,\u201d King said, \u201cnow creates discrimination because of its complexity.\u201d She added that this is how systemic discrimination is perpetuated, even if systems or rules appear seemingly neutral.<\/p>\n

How low reimbursement rates make women\u2019s lives worse<\/p>\n

The US healthcare system has never been especially good at putting its money where its mouth is when it comes to women\u2019s health. Experts have been sounding the alarm on sex-based disparities in medical billing for a long time \u2014 long enough that governing authorities like the committee responsible for RVUs and ACOG have had time to respond to the concerns.<\/p>\n

Over the years, the gap between male-specific procedure reimbursements and female-specific reimbursements has decreased slightly. But researchers of the Price and Prejudice<\/a> study showed that between 2003 and 2023, there were no statistically significant improvements to the pay disparities. Comparing a smaller set of procedures across 1997, 2015 and 2023, they found that the gap had narrowed only minimally.<\/p>\n

One common justification that ACOG provides for the pay gap is that obstetrics and gynecologic services see a higher-than-average share of patients<\/a> on Medicaid, which pays doctors less than other insurers. King agreed this is a real factor, but it doesn\u2019t explain why Medicare itself values procedures on women lower in the first place. And as her account of double discrimination makes clear, undervaluing gynecology ultimately affects women everywhere for the worse.<\/p>\n

\u201cI have patients who are waiting for surgery with me for a year at a time. I mean, that\u2019s crazy.\u201d<\/p>\n

\u2014 Dr. Louise King<\/p>\n

Lower reimbursements in gynecologic surgery disproportionately affect female surgeons because they represent a majority of this specialty. It\u2019s not just the surgeons\u2019 salaries that are affected. Hospitals and facilities work on a revenue-based model \u2014 if gynecologic surgeries are not bringing in enough money, institutions tend to allocate fewer resources to those procedures. That, in turn, can limit access to operating rooms, surgical staff, and operating times.<\/p>\n

\u201cI have patients who are waiting for surgery with me for a year at a time. I mean, that\u2019s crazy,\u201d King said. As a minimally invasive gynecologic surgeon, she surgically treats women with endometriosis, fibroids, cysts or other such conditions.<\/p>\n

It also affects the training that gynecologic surgeons receive. When there aren\u2019t enough resources to operate regularly, opportunities to train residents are rarer than they should be. The result is that low reimbursement rates have contributed to a workforce of low-volume gynecologic surgeons who are sometimes not as well-trained as other surgeons who operate frequently.<\/p>\n

The relationship between volume of surgeries performed and patient outcomes is well-documented in other fields. Research shows that surgeons who operate infrequently have worse outcomes<\/a>, including more complications before, after, and during surgeries, compared to surgeons who operate regularly.<\/p>\n

Low volume gynecologic surgeons \u2014 who perform a particular procedure less than 12 times a year \u2014 have significantly higher rates<\/a> of causing bowel and urinary tract injuries in their patients. Especially in benign gynecological surgery (procedures not related to cancer), having surgeons who operate frequently also increases the amount of minimally invasive procedures performed, which is related to better patient outcomes.<\/p>\n

Payment reform is an uphill battle, but not a lost cause<\/p>\n

It takes multiple years and pressure from different entities to update or add new RVUs for procedures \u2014 but crucially, it is not impossible. The first few steps<\/a> to creating a sustainable system might look like submitting gynecology-related procedure codes for reevaluation to the AMA committee or prompting a congressional report on the matter.<\/p>\n

For example, for years there has only been one billing code for endometriosis<\/a>, regardless of the complexity of surgery or technique used. This disincentivizes surgeons from taking on complicated surgical cases of endometriosis because of the low reimbursement rate. Reevaluating that rate or diversifying the various surgical approaches that different cases require would help affected women get the care they deserve.<\/p>\n

Medicare\u2019s payment system also has what\u2019s called a budget neutrality rule, which dictates that significantly increased payments for any given procedure must be offset by cuts elsewhere. The AMA itself<\/a> believes that reforming this rule would make it easier to work toward reimbursement equity for female-specific procedures.<\/p>\n

Experts have suggested creating gynecology-specific conversion factors<\/a> to bring parity to a system that naturally undervalues these procedures, while others think that eliminating sex-specific billing codes<\/a> whenever possible is the right move. For example, the code for genitalia biopsies is different for men and women. This means that those procedures can be reimbursed differently even though they are essentially similar. Adopting one sex-neutral code for any genitalia biopsies would avoid this. While the reform required for this would be substantial, researchers believe that it would narrow the billing gap significantly.<\/p>\n

Authorities often justify lower RVUs for female-specific procedures by pointing to training: Gynecologists spend fewer years learning to operate than urologists and other higher-paid surgical specialists, according to King.<\/p>\n

Historically, surgeons who operated on the female pelvis trained in ways that were more closely aligned with general surgeons than OB-GYNs. When obstetrics and gynecology merged into one specialty in the 1900s, the training for gynecologic surgery was truncated.<\/p>\n

\u201cGeneral OB-GYNs will train for four years and of that four years about 18 months is devoted to surgical training in gynecology,\u201d said King, contrasting the new training period to those of general surgeons which is in years.<\/p>\n

She believes that training periods should be increased for gynecologic surgeons. That change would secure better reimbursement for the speciality, while also producing better trained surgeons who would be more attuned to advances in minimally invasive surgery that will ultimately improve the outcomes for their female patients. In some cases<\/a>, the experience gained during a two-year fellowship in gynecologic surgery was equivalent to 19 years in practice.<\/p>\n

In their initial work on double discrimination, Watson and King argued that failing to implement solutions for parity is tantamount to saying that female patients deserve less well-trained surgeons than male patients.<\/p>\n

As with most women\u2019s health issues, it is unclear if this systemic disparity in medical reimbursement is the result of conscious misogyny or a by-product of ignorance. But that question of origins matters little when its consequences have been enshrined in medical policy, with lasting consequences for the practice of medicine more generally. We have allowed this wage gap to persist, even as many have sounded the alarm for decades. It is long past time to heed their warnings.<\/p>\n

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Vox Editor-in-Chief<\/p>\n","protected":false},"excerpt":{"rendered":"In the moody alcoves of a lobby bar in Chicago in 2021 over French 75s, Dr. Louise King,…\n","protected":false},"author":2,"featured_media":868352,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[29583,29584,97,252,253,1343,5599,166767],"class_list":["post-868351","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-care","tag-explainers","tag-future-perfect","tag-health","tag-health-care","tag-healthcare","tag-policy","tag-public-health","tag-the-highlight"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/868351","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=868351"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/868351\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/868352"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=868351"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=868351"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=868351"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}