# The ‘Double Discrimination’ in Medical Billing: Why Women’s Health Procedures Pay Less

- Link: https://viralbrief.top/the-double-discrimination-in-medical-billing-why-womens-health-procedures-pay-less/
- Published: 2026-10-24T13:57:42+00:00
- Author: 

## A Persistent Pay Gap

For decades, medical professionals have grappled with a systemic issue that has 
been dubbed “double discrimination.” The term, coined by bioethics professor Katie
L. Watson, refers to the dual reality that gynecologic surgeons—who are predominantly
women—are consistently paid less for their services than their counterparts performing
comparable procedures on male anatomy. This disparity persists even when controlling
for factors such as rank, age, and specialty.

The issue was highlighted as early as 1997 in the journal _Gynecologic Oncology_,
in a paper titled “Is Adam worth more than Eve?” The study found that doctors were
reimbursed approximately 44 percent more for male-specific procedures than for analogous
female-specific ones. Despite the passage of nearly three decades, experts note 
that this inequality has not only remained but has become institutionalized within
the billing codes that govern the healthcare industry.

## The Mechanics of Valuation

The financial valuation of medical procedures is determined by the Centers for Medicare
and Medicaid Services (CMS), which utilizes a metric known as relative value units(
RVUs). These units are intended to reflect the time, skill, and intensity required
for a specific procedure. Because private insurers often align their reimbursement
rates with these federal figures, the RVU serves as a primary driver of physician
compensation.

The process for setting these values often relies on self-reported surveys from 
medical societies, where doctors estimate the effort involved in their own procedures.
A 2023 study from the Mount Sinai Health System, titled “Price and Prejudice,” analyzed
55 pairs of sex-specific procedures. The researchers discovered that 75 percent 
of the procedures performed on female patients carried lower RVUs. On average, male-
specific procedures were valued 30 percent higher, leading to roughly 26 percent
higher compensation for surgeons in hospital or surgical center settings.

A concrete example of this disparity is found in biopsy procedures. According to
2023 data, the standard national reimbursement rate for a penile biopsy was $121.32,
while a vaginal biopsy was reimbursed at just $65.74.

## Consequences for Patient Care

The impact of these billing discrepancies extends beyond the bank accounts of individual
surgeons. When gynecological procedures yield lower financial returns, hospitals
face a disincentive to invest in women’s health services. This can result in a reduction
of available resources for these departments and, critically, a decrease in training
opportunities for the next generation of surgeons specializing in women’s health.

## The Path Toward Reform

While the problem is deep-seated, advocates like Dr. Louise King and Katie L. Watson
argue that it is not insurmountable. Healthcare billing is a dynamic system; procedures
are frequently reevaluated, and new codes are added as medical practices evolve.
For instance, significant changes to maternity care billing are scheduled for next
year, which will reorganize how prenatal, delivery, and postpartum services are 
reimbursed.

However, experts emphasize that gynecologic surgery—which encompasses the majority
of a woman’s life outside of childbearing—remains largely absent from these reform
conversations. To close the gap, advocates suggest that medical societies and federal
regulators must move toward removing sex-specific billing codes and fundamentally
reconsidering how the value of gynecologic procedures is calculated.

**Source:** [vox.com](https://www.vox.com/the-highlight/504071/medical-billing-womens-health-outcomes)

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  TL;DR (AI Generated)

Gynecologic surgeons, who are predominantly women, face a persistent pay gap where
they receive lower compensation for procedures on female anatomy compared to comparable
male procedures.

This disparity is driven by federal relative value units and billing codes that 
consistently assign lower valuations to women's health services.

Beyond reducing surgeon compensation, these financial discrepancies create hospital
disincentives for investing in women's health and training future specialists, though
advocates emphasize that the dynamic billing system can be reformed.

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