If the topic of how much money people make is of interest, this was a banner week. First, on Tuesday, we had Equal Pay Day, an event to draw attention to the gap between the earnings of men and women. Then, the very next day, the Centers for Medicare and Medicaid Services released a mammoth dataset, documenting almost every payment they made to doctors in 2012. The proximity of those two events raised an interesting question: were there any sex-based differences in who received Medicare money?
The short answer is yes. Massive differences.
Only 3 percent of the top 100 Medicare billers were women. Broaden the list to the top 1,000 billers, and women make up more of the pool, but still only hit 7 percent. Even if you look at the top 10,000 recipients of Medicare money, you don’t even get to 11 percent women. It’s not that no women bill Medicare. Take the whole dataset — all 880,000 providers — and women make up almost 40 percent of the names. They’re just hugely under-represented at the top of the list.
It’s a bit mysterious why the ranks of the top-billers should be so overwhelmingly male. Yes: medicine remains heavily male, with women making up about 30 percent of physicians. But there’s a big difference between a 30/70 split and a 3/97 split. What gives?
We thought that specialty might have something to do with it. As has been widely reported, ophthalmologists dominated the top-biller list. And ophthalmology is not necessarily a practice area with an even sex breakdown. Could it just be that women tend not to be in the specialties prone to huge Medicare billing?
The answer is less than satisfying. Yes: ophthalmology is only about 20 percent female, which would clearly explain part of the discrepancy. But even 20 percent doesn’t get down to the kind of lopsidedness seen with the top billers. Hematology/oncology and radiation oncology, which round out the top 3 most expensive specialties for Medicare, are 27.4 percent and 24.9 percent women, respectively.
There is also the question of length of practice. Women have (almost) been at parity in med school graduation rates only for about the past decade, but the data shows that the highest-billing docs graduated from med school in the 1980s and the 1970s. Per capita, docs that left school in the ’80s took in $101,000 in Medicare billings. For those who graduated in the ’70s, the figure is $99,000 per person. That’s more than twice the $49,000 per capita that a graduate from the 2000s took in from Medicare last year. In the 1970s, only 16 percent of med school grads were women. In the 1980s, that bumped up to 30 percent.
So, again: massive inequality, but not massive enough to explain away the gigantic gap at the top of the billing list. Perhaps the two factors work in synergy — older doctors working in specialties with uneven composition, sex-wise — is enough to make the ratio of men to women at the top of the Medicare chart so off-kilter. But that seems unlikely. There must be other forces at work.
So like any great mystery in the Internet age, we need to crowd-source this one: let us hear your theories on women aren’t better represented among high-billing Medicare physicians. If we can check the dataset for answers, we’ll append those findings here.