The insidious, fascinating, and utterly infuriating reason that women’s health care is worse than men’s

Female surgeons and bioethics professors discussed the issue of pay disparity in the medical field, noting that female surgeons are consistently underpaid compared to male surgeons despite accounting for factors like specialty, rank, and age. This situation is described as "double discrimination" because women face lower pay not only for gynecological surgeries, which are predominantly performed by women, but also because this specialty serves a primarily female patient population. Key findings indicate that doctors are paid less for gynecological surgeries than for comparable male-specific procedures, a gap that has not improved significantly over the last two decades.
The valuation of medical procedures is largely determined by a committee relying on self-reported data, which leads to disparities; studies showed that out of sex-specific procedures evaluated, 75 percent had lower relative value units (RVUs) for female patients compared to male patients. This undervaluation has consequences for the healthcare system, as hospitals may allocate fewer resources to women's health services, potentially leading to worse patient outcomes and limiting training opportunities.
Efforts for reform involve reconsidering how gynecological surgeries are valued, removing sex-specific billing codes, and utilizing more objective data sources like surgical quality improvement programs to determine reimbursement rates. Changes in billing systems, such as the upcoming split of maternity care services, present opportunities for broader reform, though the specific valuation of gynecologic surgery remains largely outside major discussions.

* Doctors are paid less for gynecologic surgeries than for similar surgeries on men.
* The pay gap has barely improved in the last 20 years.
* The value of a procedure is set by a committee using self-reported surveys of doctors regarding skill and time.
* A study found that out of 55 pairs of sex-specific procedures evaluated, 75 percent had lower RVUs for female patients.
* On average, RVUs for male-specific procedures were 30 percent higher than for female-specific ones in a study comparing pain/genitalia biopsies.
* Medicare’s standard rate for a penile biopsy was $121.32, while for a vaginal biopsy it was $65.74 in 2023.
* The committee setting RVUs is composed of doctors from medical societies, with most seats allocated to members of major medical societies.
* Analysis of surgeries using the National Surgical Quality Improvement Program and self-reported surveys showed that gynecologic surgeons had lower median RVUs per hour than other specialties studied.
* Urologists reported procedure times exceeding baseline data by a median of 20 minutes, while gynecologists only exceeded actual time by a median of five minutes in one analysis.
* The American College of Obstetricians and Gynecologists (ACOG) has a seat on the RVU committee, but most members are general OB-GYNs who operate infrequently.
* Surgeons operating infrequently have been found to have worse outcomes and higher rates of complications compared to those who operate regularly.

The systemic devaluation of gynecological services is rooted in a mechanism where subjective, self-reported data, filtered through an established committee structure, codifies existing gender biases into the economic framework of healthcare reimbursement. The core tension lies between objective clinical outcomes and the inherently flawed valuation system that relies on expert consensus rather than verifiable performance metrics.
The pattern observed is one of institutional inertia: existing structures, like the RVU determination process dominated by general practitioners, are not designed to correct historical disparities but rather perpetuate them. This creates a feedback loop where low reimbursement limits resource allocation, which subsequently restricts training opportunities and leads to fewer high-volume surgeons, thereby cementing the disparity for future rates. The fact that the system is complex and opaque—relying on self-reported time over objective surgical logs—serves as a mechanism of systemic discrimination, regardless of the intent of the individuals involved.
The argument that this disparity stems from ignorance versus conscious misogyny invites deeper inquiry into the historical trajectory of medical specialization and training. The finding that training periods for gynecologic surgeons are shorter than those for general surgeons suggests an embedded structure where female-specific surgical expertise has been historically devalued during professionalization. Moving forward requires dismantling these institutional mechanisms by prioritizing objective, longitudinal data collection and introducing structural changes, such as sex-neutral coding or enhanced representation on valuation committees, to shift the paradigm from perceived necessity to measurable equity.
Bridge Questions: If the underlying data collection systems are inherently biased toward general surgical practice, what specific, independently verifiable metrics could replace or supplement self-reported survey data to ensure true procedural value reflects clinical reality? What policy mechanisms are necessary to force representation change within bodies like the AMA and ACOG to prioritize outcomes over perceived specialty volume when setting reimbursement rates? What is the long-term effect of relying on expert consensus in opaque systems versus mandated, transparent statistical analysis for medical valuation?