Is There a Gap? Examining Gender Disparities in Industry Payments and Their Geographic Distribution Among Plastic Surgeons

Abstract

PURPOSE: Various medical specialties have demonstrated gender disparities involving industry-supported payments. We sought to determine if such gender disparities exist within plastic surgery across all practice settings over a multiyear time period and to characterize such discrepancies by payment category and geographical location. METHODS: Industry contributions to plastic surgeons practicing in the United States were extracted from the Centers for Medicare and Medicaid Services Open Payments 2013–2017 databases. Specialists’ gender was obtained through online searches. Kruskal-Wallis tests compared payments (USD) by gender, both overall payments and by payment category. Linear regression estimated the independent association of female gender with increased/reduced payments while controlling for state-level variations. RESULTS: Of 1,518 plastic surgeons across private and academic settings, 13.4% were female. Out of $44.4M total payments from the industry, $3.35M were made to females (P < 0.01). During the study period, female plastic surgeons received lower overall payments than males (median [interquartile range (IQR)], $3,500 [$800–$9,500] versus $4,160.60 [$1,000–$19,728.20]; P < 0.01). This trend persisted nationwide after normalizing for year (median [IQR], $2,562.50/y [$770–$5,916.25] versus $3,200/y [$955–$8,715.15]; P = 0.02) and at the state-level in all 38 states where there was female representation. Analysis of payment categories revealed that honoraria payments were significantly higher for males (median [IQR], $4,738 [$1,648–$16,100] versus $1,750 [$750–$4,100]; P = 0.02). Within risk-adjusted analysis, female plastic surgeons received $3,473.21/y (95% CI, $671.61–$6,274.81; P = 0.02) less than males. CONCLUSIONS: Gender disparities involving industry payments exist in plastic surgery both at a national- and state-level and across all settings—from private to academic surgeons. Factors contributing to this phenomenon must be explored to understand implications of this gap.