title: Differences in Clinical Activity and Medicare Payments for Female vs Male Ophthalmologists.
abstract: OBJECTIVE
  The number of women in ophthalmology is rising. Little is known about their clinical activity and collections.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Wilmer Eye Institute, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ashvini K
authors.initials: AK
authors.lastname: Reddy
authors.affiliation: The University of Texas School of Public Health, Houston.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Bounds
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Sophie J
authors.initials: SJ
authors.lastname: Bakri
authors.affiliation: Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Lynn K
authors.initials: LK
authors.lastname: Gordon
authors.affiliation: Department of Ophthalmology, Flinders University, Adelaide, South Australia.
authors.forename: Justine R
authors.initials: JR
authors.lastname: Smith
authors.affiliation: Wills Eye Hospital, Philadelphia, Pennsylvania.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Haller
authors.affiliation: Bascom Palmer Eye Institute, Miami, Florida.
authors.forename: Audina M
authors.initials: AM
authors.lastname: Berrocal
authors.affiliation: Wilmer Eye Institute, The Johns Hopkins University, Baltimore, Maryland8Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Thorne
mesh_terms: D005251:Fees, Medical / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D000072163:Ophthalmologists / Q000191:economics*; D009885:Ophthalmology / Q000191:economics; D010036:Otolaryngology / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States; D000078329:Workforce