1020 The Gender Dynamics of Spine Surgery Payments: Trends and Disparities in Medicare Reimbursements

INTRODUCTION: Despite substantial growth in Medicare expenditures from $586 billion in 2013 to $829 billion in 2021, the specifics of how these funds are allocated for spine surgery based on gender remain under-analyzed. Surgery as a specialty continues to display significant gender imbalances among practitioners, and available literature shows a noted decline in reimbursement rates. METHODS: Using publicly available data from the Centers for Medicare & Medicaid Services spanning 2013 to 2021, we focused on 57 distinct CPT codes linked to spine surgery. Our comprehensive analysis assessed gender disparities across several dimensions, including the total number of spine services provided, total Medicare payments, charges for spine procedures, and the average Medicare reimbursement per procedure. RESULTS: The analysis revealed a universal decrease in Medicare reimbursement per procedure across both specialties and genders over the study period. Male surgeons consistently received higher average reimbursements than their female counterparts in both neurosurgery and orthopedics. Female orthopedic surgeons, in particular, faced statistically significantly lower reimbursements per procedure compared to males in both 2013 and 2021 —a disparity not mirrored in neurosurgery. Interestingly, the volume of procedures performed by female neurosurgeons was approximately three times that of female orthopedic surgeons. CONCLUSIONS: The study highlights significant gender disparities in Medicare reimbursements within spine surgery. Male surgeons consistently received higher compensations than females, with marked disparities in orthopedics. This reflects a systemic issue in financial recognition and suggests a need for a gender-sensitive review of reimbursement policies to ensure equitable compensation. Addressing these disparities is crucial for enhancing the recruitment, retention, and satisfaction of female surgeons and warrants further investigation into the causes of these payment discrepancies.