In the landscape of American healthcare, a systemic disparity persists in how medical procedures are valued, one that effectively places a lower price tag on the female body. Despite decades of advocacy and peer-reviewed research, surgeons who perform procedures specifically for women continue to be reimbursed at lower rates than those performing analogous surgeries on men, a phenomenon medical experts have termed “double discrimination.”
The term, coined by Dr. Louise King, a gynecologic surgeon and director of reproductive bioethics at the Harvard Medical School Center for Bioethics, and Katie L. Watson, a bioethics professor, describes a two-fold dilemma. Gynecologic surgery is a field predominantly comprised of female physicians treating female patients, and yet the financial value assigned to their work has historically lagged behind male-dominated specialties like urology.
At the center of this disparity is the Relative Value Unit (RVU), a metric used by the Centers for Medicare and Medicaid Services (CMS) to determine how much a procedure is worth. RVUs are intended to reflect the time, skill, and intensity required for a specific medical act. However, a 2023 study from the Mount Sinai Health System titled “Price and Prejudice” found that out of 55 pairs of sex-specific procedures, 75 percent had lower RVUs for procedures on female patients. On average, male-specific procedures were valued 30 percent higher. In practice, this means a surgeon might be paid $121.32 for a penile biopsy but only $65.74 for a vaginal biopsy, despite both requiring similar equipment and expertise.
The process of setting these values is largely handled by a committee convened by the American Medical Association (AMA). This committee relies on self-reported surveys from doctors to estimate the time and effort required for various procedures. Research indicates that this data is frequently skewed. Dr. Shitanshu Uppal, a gynecologic oncologist at the University of Michigan, analyzed nearly one million surgeries and found that specialties focused on male anatomy, such as urology, tended to overestimate their surgical times in surveys by a median of 20 minutes. In contrast, gynecologists overestimated by only five minutes. Because higher reported times lead to higher RVUs, this discrepancy cements a higher hourly rate for those treating male patients.
The consequences of this undervaluation extend far beyond the paychecks of individual doctors. Because hospitals operate on revenue-based models, services that generate lower reimbursements often receive fewer institutional resources. Dr. King noted that this leads to restricted access to operating rooms and surgical staff for gynecological procedures. “I have patients who are waiting for surgery with me for a year at a time,” King said, referring to waitlists for treating endometriosis, fibroids, and cysts.
Furthermore, the financial gap impacts the quality of surgical training. When gynecologic surgeries are not prioritized, residents have fewer opportunities to operate, leading to a workforce of “low-volume” surgeons. Studies show that surgeons who perform certain procedures fewer than 12 times per year have significantly higher rates of complications, including bowel and urinary tract injuries.
Advocates suggest several paths toward parity, including the removal of sex-specific billing codes. By adopting a single, gender-neutral code for procedures like genitalia biopsies, the billing system could eliminate automatic price differences based on anatomy. Additionally, reforming Medicare’s “budget neutrality” rule—which requires that any payment increase for one procedure be offset by cuts elsewhere—could allow for a more equitable reevaluation of women’s health services without penalizing other specialties.
While some progress was made between 1997 and 2023, researchers note that the gap has narrowed only minimally. For gynecologic surgeons and their patients, the persistence of these codes remains a barrier to both economic equity and the standard of care.
