Gender Disparities in the Spine Surgeon Workforce Performing Cervical Spine Surgery in the Medicare Population.

Abstract

Gender disparities persist across surgical specialties including orthopaedic surgery and neurosurgery, which may limit workforce diversity and potentially influence care delivery. Understanding representation among spine surgeons performing common procedures such as anterior cervical diskectomy and fusion (ACDF) may identify opportunities to enhance equity. This was a retrospective cross-sectional study of spine surgeons performing ACDF using Medicare Provider Utilization and Payment Data from 2013 to 2021. The total representation of female spine surgeons performing ACDF, including their case volumes, practice characteristics, and payments, was compared with that of male spine surgeons. A total of 2,492 spine surgeons who performed 139,456 ACDF cases were included in the sample. Of these, 58 female spine surgeons (2.3%) performed 2,733 cases (2.0%). The percentage of female surgeons increased from 0% (0/1,124) in 2013 to 1.8% (12/651) in 2021 (β = 0.163, R2 = 0.263, P < 0.001). The average annual volume of ACDF procedures was similar between female and male surgeons (16.8 ± 3.6 vs. 17.2 ± 7.6, P = 0.712). No difference was observed in academic teaching hospital affiliation between female and male surgeons (13.9% vs. 11.8%, P = 0.697). No difference was found in mean standardized Medicare reimbursement for ACDF procedures over the study period (P = 0.145). In 2021, female surgeons treated a higher proportion of female patients (56.8% vs 55.0%, P = 0.043). Although representation of female spine surgeons increased modestly, gender disparities remain pronounced within the Medicare workforce. Strategies are needed to increase the number of female trainees interested in a career in spine surgery.