Assessment of Differences in Clinical Activity and Medicare Payments Among Female and Male Radiation Oncologists.

Importance: Although physician sex is known to influence salary even after controlling for productivity, sex-based differences in clinical activity and reimbursement among radiation oncologists are poorly understood. Objectives: To evaluate differences by sex in productivity, breadth of practice, and payments and to characterize Medicare reimbursement by sex among similarly productive groups of radiation oncologists. Design, Setting, and Participants: A retrospective cohort study was conducted using the January 1 to December 31, 2016, Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use File (POSPUF) to identify charge and payment information for individual radiation oncologists. Clinicians were part of a population-based sample of US radiation oncologists who bill Medicare in both non-facility-based (NFB) and facility-based (FB) practice settings. Analysis was conducted from June 5 to 25, 2018. Main Outcomes and Measures: Outcome measurements included physician productivity (measured by number of Medicare charges), physician payments (reported as total Medicare payments as well as mean payments per charge submitted and per beneficiary treated), and physician breadth of practice (measured by number of unique Medicare billing codes) in NFB and FB settings. Results: A total of 4393 radiation oncologists (1133 women and 3260 men) were included in the POSPUF in 2016. Compared with their male counterparts, female physicians in the NFB setting submitted a mean of 1051 fewer charges (95% CI, -1458 to -644; P < .001), collected a mean of $143 610 less in revenue (95% CI, -$185 528 to -$101 692; P < .001), and used a mean of 1.32 fewer unique billing codes (95% CI, -2.23 to -0.41; P = .004). Compared with their male counterparts, female radiation oncologists in the FB setting submitted a mean of 423 fewer charges (95% CI, -506 to -341; P < .001), collected a mean of $26 735 less in revenue (95% CI, -$31 910 to -$21 560; P < .001), and submitted a mean of 1.28 fewer unique billing codes (95% CI, -1.77 to -0.78; P < .001). Women represented 46 of the 397 most highly productive radiation oncologists in the FB setting (11.6%) and collected a mean of $33 026 less (95% CI, -$52 379 to -$13 673; P = .001) than men who were similarly productive. In the NFB setting, women represented 54 of the 326 most highly productive radiation oncologists (16.6%) and collected $345 944 (95% CI, -$522 663 to -$169 225; P < .001) less than similarly highly productive men. Women collected a mean of $8.49 less per charge (95% CI, -$14.13 to -$2.86; P = .003) than men in the NFB setting. Conclusions and Relevance: This study suggests that female radiation oncologists submit fewer Medicare charges, are reimbursed less per charge they submit, and receive lower Medicare payments overall compared with male radiation oncologists. Even among similarly productive radiation oncologists, women in this study still collected less revenue than men. Further research is required to understand the sex-based barriers to economic advancement within radiation oncology.