Medicare Billing and Reimbursement Differ for Women and Men in Ophthalmology—Reply

Ashvini K Reddy, Justine R Smith, Jennifer E Thorne

Research output: Contribution to journalLetterpeer-review


In Reply We appreciate the opportunity to respond to the letter by Salim and Christmann regarding our article.1 We agree that equity and parity in ophthalmology are important topics given the increasing number of women entering this profession.2We agree that the results should be interpreted with caution, as is the case with any analysis of a single-payer database. Indeed, these limitations of our study, and the Centers for Medicare & Medicaid Services (CMS) database we used, are addressed in the Discussion section of our article. Many of these limitations are common to virtually all studies of physician compensation, with many additional variables being informative but not available for analysis. At the time of our data analysis, only data from years 2012 and 2013 were publically available from CMS, and therefore we were unable to look at any subsequent years. While CMS does not cover most of the US population, many of the patients seen by ophthalmologists are Medicare-eligible and are treated for age-related eye disease; therefore, we considered that this database was a reasonable and robust data set with which to begin our investigations. Further publications that investigate other insurance databases would certainly be helpful in broadening the literature.Interestingly, the focus of the comment appears to be on terminology and variables that were not possible to include rather than the big picture. From all the information we could collect, to provide the most complete picture possible, there is nonparity for women in this field in many areas (eg, editorial positions,3 industry partnerships,4 clinical activity,1 and CMS collections1) and, as suggested by Fitch,5 cited by Salim and Christmann, this inequity appears to be greater in ophthalmology than in most other medical professions. Salim and Christmann expressed concern that the analysis could influence compensation decisions by employers. To be clear, nowhere do we find justification for paying women less. We agree that this would be a misinterpretation of the data that we have presented in our article.
Original languageEnglish
Pages (from-to)1006
Number of pages1
JournalJAMA Ophthalmology
Issue number9
Publication statusPublished - Sep 2017


  • Women
  • ophthalmology
  • physician compensation
  • Medicare


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