Evidence map›Paper›PMID 37402558›Full record

ArticleCanadian journal of surgery. Journal canadien de chirurgie

Surgical sexism in Canada: structural bias in reimbursement of surgical care for women.

Michael Chaikof, Geoffrey W Cundiff, Fariba Mohtashami, Alexi Millman, Maryse Larouche, Marianne Pierce, Erin A Brennand, Colleen McDermott

Erratum issuedAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Canadian journal of surgery. Journal canadien de chirurgie. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 10 papers.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2024
    Article
  5. Addressing the root causes of the sex-based pay gap in medicine in Canada.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2024
    Article
  6. Article
  7. Creation and Program Evaluation of a Women in Surgery in ENT (WISE) Group.Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale
    Article
  8. Article
  9. Why are we ignoring gender equity in surgery?Canadian journal of surgery. Journal canadien de chirurgie
    Article
  10. The Yukon data are incorrect.Canadian journal of surgery. Journal canadien de chirurgie
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Michael ChaikofFrom the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand) michael.chaikof@mail.utoronto.ca.
Geoffrey W CundiffFrom the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand).
Fariba MohtashamiFrom the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand).
Alexi MillmanFrom the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand).
Maryse LaroucheFrom the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand).
Marianne PierceFrom the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand).
Erin A BrennandFrom the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand).
Colleen McDermottFrom the Division of Female Pelvic Medicine and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Chaikof, McDermott); the Departments of Obstetrics & Gynaecology, and Urologic Sciences, University of British Columbia, Vancouver, BC (Cundiff, Mohtashami); the Division of Pelvic Health and Reconstructive Urology, Department of Urology, University of Illinois at Chicago, Chicago, Ill. (Millman); the Departments of Obstetrics and Gynecology, and Surgery, McGill University, Montréal, Que. (Larouche); the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Pierce); the Departments of Obstetrics and Gynaecology, and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Brennand).

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIt is well established that female physicians in Canada are reimbursed at lower rates than their male counterparts. To explore if a similar discrepancy exists in reimbursement for care provided to female and male patients, we addressed this question: Do Canadian provincial health insurers reimburse physicians at lower rates for surgical care provided to female patients than for similar care provided to male patients?

methodsUsing a modified Delphi process, we generated a list of procedures performed on female patients, which we paired with equivalent procedures performed on male patients. We then collected data from provincial fee schedules for comparison.

resultsIn 8 out of 11 Canadian provinces and territories studied, we found that surgeons were reimbursed at significantly lower rates (28.1% [standard deviation 11.1%]) for procedures performed on female patients than for similar procedures performed on male patients.

conclusionThe lower reimbursement of the surgical care of female patients than for similar care provided to male patients represents double discrimination against both female physicians and their female patients, as female providers predominate in obstetrics and gynecology. We hope our analysis will catalyze recognition and meaningful change to address this systematic inequity, which both disadvantages female physicians and threatens the quality of care for Canadian women.

Indexed as

SexismSurgeonsCanadaFemaleHumansMalePregnancy

Identifiers

PMID37402558
PMCPMC10322158

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.