Gender and compensation among surgical specialties in the Veterans Health Administration.

BACKGROUND: A gender pay gap has been reported across many professions, including medicine. METHODS: Surgeons employed at complex Veterans Affairs Medical Centers (VAMC) nationwide in 2016 were identified. Data on salary, gender, years since medical school graduation, professorship status, h-index, and geographic location were collected. RESULTS: Of 1993 surgeons nationwide, 23% were female. On average, female surgeons had significantly lower salaries compared to male surgeons ($268,429 ± 41,339 versus $287,717 ± 45,379, respectively; p < 0.001). Among each surgical specialty, there were no significant differences in salary on univariate analysis. Women were underrepresented in higher paying specialties and more heavily represented in lower paying specialties. On multivariate analysis, gender (p < 0.001), time since medical school graduation (p < 0.001), surgical specialty (p = 0.031), h-index (p < 0.001), and geographic location (p < 0.001) were significant predictors of salary. CONCLUSION: Female gender significantly predicted lower salary among VAMC surgeons, however within each surgical specialty, there was no significant gender pay gap. SENTENCE SUMMARY: Independent predictors of salary included gender, surgical specialty, experience, h-index, and geographic location. Although female surgeons had lower overall salaries compared to male surgeons in the Veterans Health Administration (VHA), there were no significant gender differences in salary among each surgical specialty. Pay transparency, unique to the VHA, along with the use of rational and objective criteria to establish and adjust salaries, may play a role in reducing the gender pay gap among VHA surgeons.

Medicare Program; physician performance standard rates of increase for fiscal year 1994 and physician fee schedule update for calendar year 1994--HCFA. Correction of final notice with comment period.

This document corrects an error that occurred in the calculation of the fiscal year 1994 Medicare volume performance standard for surgical services and that appeared in the final notice with comment period published in the Federal Register on December 2, 1993 (58 FR 63856) entitled "Medicare Program; Physician Performance Standard Rates of Increase for Fiscal Year 1994 and Physician Fee Schedule Update for Calendar Year 1994." This notice also corrects a typographical error in a date.

Physician performance standard rates of increase for federal fiscal year 1994 and physician fee schedule update for calendar year 1994--HCFA. Final notice with comment period.

This notice announces the calendar year (CY) 1994 updates to the Medicare physician fee schedule and the Federal fiscal year (FY) 1994 performance standard rates of increase for expenditures and volume of physicians' services under the Medicare Supplementary Medical Insurance (Part B) program as required by sections 1848 (d) and (f), respectively, of the Social Security Act. The physician performance standard rates of increase for Federal FY 1994 are 8.6 percent for surgical services, 10.5 percent for primary care services, 9.2 percent for other nonsurgical services, and 9.3 percent for all physicians' services. The fee schedule update for CY 1994 is 10.0 percent for surgical services, 7.9 percent for primary care services, and 5.3 percent for other nonsurgical services. This notice also references the surgical and nonsurgical designations for new and revised procedure codes in the Physicians' Current Procedural Terminology, to be used in applying the CY 1994 updates and for establishing and measuring expenditures under the MVPS for FY 1994. These designations appear in Addendum C of the final rule with comment period entitled "Medicare Program; Revisions to Payment Policies and Adjustments to the Relative Value Units under the Physician Fee Schedule for Calendar Year 1994 (BPD-770-FC)," published elsewhere in this Federal Register issue. The new and revised surgical and nonsurgical designations are subject to public comment. In addition, this notice addresses public comments on the "initial" procedure-specific list of surgical services published in our November 25, 1992, notice.

Repeal of the Sustainable Growth Rate: an overview for surgeons.

BACKGROUND: The Medicare sustainable growth rate (SGR) formula is used to control Medicare spending on physician services. Under the current SGR formula, physicians face an almost 24% cut to the Medicare fee schedule on April 1, 2015. The US House Way & Means and Energy & Commerce Committees and the Senate Finance Committee released jointly proposed legislation to permanently repeal the SGR, and transition Medicare physician payment to a value-based payment method. This review summarizes the key components of the proposed legislation, and discusses some of the political challenges ahead. DATA SOURCES: House Committees on Energy & Commerce and Ways & Means, and the Senate Committee on Finance staff write-ups. CONCLUSIONS: Physician Medicare reimbursement will move from a volume-based model to a value-based model over the next decade. Surgeons should remain engaged with the political process to ensure repeal of the SGR.