Trends in Gender Representation and Impact of Practice Setting on Productivity and Reimbursement Gap for Female Mohs Micrographic Surgery Physicians: A Cross-sectional Study

Abstract

BACKGROUND Mohs micrographic surgery (MMS) is a male-predominant dermatologic subspecialty. The impact of practice setting and gender composition on the productivity and reimbursement of female MMS surgeons has not been thoroughly examined. OBJECTIVE To determine changes in female representation, productivity, and Medicare reimbursement across practice types. MATERIALS AND METHODS Retrospective cross-sectional analysis of Centers for Medicare and Medicaid Services database for Medicare Part B claims during pre–COVID-19 (2013–2019) and post–COVID-19 (2019–2022) pandemic. RESULTS From 2013 to 2019, the number of MMS surgeons billing Medicare increased by 22% from 2,135 to 2,605, with proportion of female physicians increased by only 4% (28% to 32%, p = .012). In 2019, female MMS surgeons performed fewer total cases and earned less payments than male counterparts across all practice settings. Productivity and reimbursement gaps, as compared to national median values for male MMS surgeons, were highest for female MMS surgeons working in mixed-gender practices (39% and 39%) and lowest in single-surgeon practices (17% and 27%). All-female multisurgeon practices saw the greatest improvement in both productivity and reimbursement gaps (55% to 25% and 47% to 29%, respectively). From 2019 to 2022, case volume decreased across all practice types, reflecting a significant COVID-19 impact on MMS services. CONCLUSION Proportion of female MMS surgeons nationwide increased very slightly between 2013 and 2022. However, productivity and reimbursement gaps remained significant and varied across practice settings.