1016 Regional Disparities in Gender-Based Financial and Relocation Patterns Among Neurosurgeons: A Comprehensive Analysis of Medicare Data

INTRODUCTION: This study delves into geographic and gender disparities in neurosurgery, examining Medicare reimbursements and relocation patterns to shed light on underlying systemic issues and advocate for gender equity initiatives. METHODS: We analyzed CMS data from 2013-2021 for gender disparities in neurosurgery across the U.S., focusing on Medicare reimbursements and practice relocation patterns. The study applied univariable and multivariable linear regression for reimbursement analysis and logistic regression for assessing relocation, adjusting for procedural diversity, service scope, and patient complexity. RESULTS: In this longitudinal study of 6,470 neurosurgeons (89.6% male, 10.4% female), we uncovered significant regional disparities in Medicare billing and reimbursements by gender. Female neurosurgeons in the West South Central region billed an average of $491,896.67 less than their male counterparts (95%CI -$595,392.11 to -$388,401.20, P<0.001), in contrast to a smaller gap of $227,53.92 in the West North Central region (95%CI -$347,640.17 to -$207,387.67,P<0.001). When examining reimbursements, a larger gap was seen in the South Atlantic division, where female neurosurgeons earned $75,103.5 less than males, while the disparity in the East South Central division was $49,242.07 (95%CI -$59,848.65 to -$38,635.48,P<0.001). Additionally, female neurosurgeons were found to be 23% more likely to change practices compared to males nationwide (OR 1.23 95%CI, 1.07–1.42,P=0.003). This trend showed significant regional variations, particularly in the South Atlantic (OR 1.65, 95% CI 1.22–2.23, P<0.001), Mountain (OR 1.78, 95%CI 1.10–2.89,P=0.019), and Pacific (OR 1.48, 95%CI 1.04–2.12,P=0.029) regions. These regional disparities in both billing practices and likelihood of practice change persisted even in adjusted models. CONCLUSIONS: Significant regional gender disparities exist in neurosurgery Medicare reimbursements and relocation tendencies, suggesting a need for targeted strategies to ensure gender equity in neurosurgery.