Medicare Pays Women in Ophthalmology Half What it Pays Men

Laird Harrison

May 05, 2022

Medicare pays female ophthalmologists only half of what it pays men, according to data analysts.

The disparity in median annual reimbursement doesn’t appear to be changing, even as more women enter the profession, said Omar Halawa, a medical student at Harvard Medical School in Boston, Massachusetts, who helped crunch Medicare’s publicly available numbers.

About $80,000 of the $100,000 difference in pay can be attributed to years of service and experience, proportion of procedural services, practice location, and socioeconomic factors, he said.

In the next phase of their research, Halawa and his colleagues would like to analyze other factors that could explain the disparity.

“The purpose of this project is to sort of illuminate this huge pay gap, and ultimately close that gap,” he said in a presentation on the data at the Association for Research in Vision and Ophthalmology (ARVO) 2022 Annual Meeting.

The problem is not unique to ophthalmology. Previous researchers have documented disparities in pay between men and women for facial plastic surgery, oral surgery, cardiology, and other medical specialties.

They have shown that female ophthalmologists earn less in their first year of clinical practice, perform fewer cataract surgeries, and get less funding from the U.S. National Institutes of Health.

Halawa and his colleagues drilled deeper into these findings by looking at longitudinal data from Medicare billing patterns for 20,281 ophthalmologists between 2013 and 2019. Seventy-six percent of the ophthalmologists in the cohort were men.

The researchers then linked this data to the U.S. Census Bureau’s American Community Survey to obtain statistics on socioeconomic factors such as poverty and education for the ophthalmologists’ practice ZIP codes.

They found that women in this dataset had fewer years of experience and billed for fewer services per year. The women also had fewer unique billing codes and a lower proportion of procedural codes.

“It's important to explore some of the reasons why women are doing fewer procedures in general,” Halawa said. “Understanding those reasons and potential sources of bias can really help us to develop policies to address that.”

Although more women are entering ophthalmology and should be accumulating more years of experience, the disparity in Medicare reimbursement did not change from 2013 to 2019.

Next the researchers looked to see whether there was a difference by the type of service provided. “We found that in all of these billing code categories, women consistently earned less than men,” Halawa said. “The greatest differences were seen in outpatient visits and eye examinations, as well as cataract surgeries and injections.”

The very top earners were even more disproportionately male. Men comprised 94% of ophthalmologists with reimbursement in the 90th percentile, and 97% of those in the 99th percentile.

The median annual reimbursement in the dataset was $94,732.21 for women and $194,176.90 for men. After the researchers adjusted for experience, location, and socioeconomics, the difference between men and women was $20,209.12.

Besides shouldering more childcare responsibilities, women may do more administrative tasks, Halawa said. “Other things that are less tangible may include differences in referral patterns, where women might get less complicated surgical patients, and are not able to bill as highly for those patients.”

In a follow-up analysis, Halawa and his colleagues examined whether Medicare paid men and women the same for the same billing codes, for example for cataract procedures of equal complexity. They found that women get about 20 cents less per code. “We don't know why,” he said.

Even if the data could be broadened to include private insurance plans, the disparity would probably not be affected much because most ophthalmology patients are covered by Medicare, he said.

The big pay gap came as a surprise to session moderator Shefali Sood, a fourth-year medical student at Georgetown University in Washington, DC. “I was expecting that Medicare reimbursements should be gender blind, especially if they're adjusting for the number of services done by both men and women,” she told Medscape Medical News.

Women might be billing for fewer services because of career and parenting decisions, or they may not negotiate as assertively for clinical time, she said. “I think it's multifaceted and something that warrants more investigation.

Halawa and Sood report no relevant financial interests.

Association for Research in Vision and Ophthalmology (ARVO) 2022 Annual Meeting. Presented May 3, 2022.

Laird Harrison writes about science, health, and culture. His work has appeared in national magazines, in newspapers, on public radio, and on websites. He is at work on a novel about alternate realities in physics. Harrison teaches writing at The Writers GrottoVisit him at www. or follow him on  Twitter: @LairdH

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