Enlightened discourse on the Internet

By Peter J. McDonnell, MD

As you know, the federal government recently decided to make public the payments by Medicare to physicians in the United States. The American Medical Association had opposed this release of data, saying that without proper background and supportive information it would be misleading, and also arguing that it violated the right to privacy of physicians. The Centers for Medicare Services (CMS) officials said they hoped “the data would be analyzed by the media and by private researchers to help ferret out fraud and discrepancies that indicate unnecessary or excessive treatments being performed.”

Whatever the merits of the wisdom (or lack thereof) of the CMS decision to put these data out in the public domain, the data reveals a few important pieces of information:

1.      Ophthalmologists rank relatively highly among subspecialties in terms of the amount of Medicare payments to physician. This did not come as a big surprise to me, as the increasing prevalence of eye diseases with age means that we largely practice a geriatric specialty.

2.     One third of the most highly CMS-supported physicians, receiving millions per year, were ophthalmologists.

3.     Sadly, yours truly was not among this group.

4.     Male physicians, compared to females in the same specialty, receive more payments from CMS.

This latter fact was the subject of a recent article. According to CNBC¹, male physicians on average were paid $118,782 by the federal government in 2012, compared to $63,346 for women doctors. Considering that Medicare pays physicians the same amount for the individual services they perform on patients in the same geographic area, why the discrepancy? The article makes several points:

1.     Male doctors, on average, saw 60% more Medicare patients than their female counterparts.

2.     Male doctors, on average, perform more procedures or services (an average of 5.7 services per patient) than do the female physicians (average of 4.7 services).

3.     Because of the greater amount of services, male doctors earn 24% more per patient ($262) than female doctors ($211).

4.     Every specialty except pathology showed this discrepancy. Even female predominant fields, like Ob-Gyn, shared the trend.

The article quotes a physician suggesting that men and women “may practice medicine differently.” This struck me as interesting, but of course there are other possible explanations for the data.

At the end of the webpage with the article, readers were invited to comment. Amongst the initial offerings were:

·      “Women take time off for childcare responsibilities.”

·      “Males work longer.”

Then the discussion rapidly degenerated:

·      “Women are lazy.”

·      “Doctors are arrogant and just out for money (males and females).” – (whether or not this is true, this person’s comment does not explain the male-female difference reported in the article).

·      “Men are more aggressive, performing unnecessary procedures to ‘milk’ the system” says “ann1234ann”.  “They got larceny in their blood,” she concluded.

·      “You are an idiot” opined one correspondent, who objected to criticism of male physicians. “You are a jarhead”came a response.

What can we conclude from this discourse? From my perspective, it would be interesting to see a dispassionate and careful study to see if men and women, in the same medical specialties, really do practice differently and, if so, why.  Also, I sure hope ann1234ann is not one of my patients!

Reference

1. Rx Gender gap!  Male MDs earn way more than females in Medicare. Tuesday April 22, 2014. http://www.cnbc.com/id/101599211