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Louise King, MD, JD




Assistant Professor




Assistant Professor


Obstetrics & Gynecology


Katie Watson JD, Shabnam Gupta MD MPH, Jon Einarsson MD PhD, Mobolaji Ajao MD MPH, Parmida Maghsoudlou

Double Discrimination, the Pay Gap in Gynecologic Surgery, and Its Association With Quality of Care and Training

I feel it is important to highlight our work that centers around various aspects of discrimination within health care specific to women as patients and as health care professionals. We highlight the issues but also propose solutions. Many within our community are not aware of these disparities, their history or how they persists. This work brings together expertise in epidemiology, statistics, health policy, ethics and law – all of which constitute my research and clinical interests.


Disparities in women’s health are well documented. The crisis of maternal mortality rates in our country is one stark example. In my field of gynecologic surgery, disparities exist in reimbursement and funding leading to lesser training in surgery, less access to minimally invasive options, and worse outcomes.1 These disparities result in lesser pay to women surgeons – who are disproportionately represented among gynecologic surgeons. We’ve termed this “double discrimination.”2,3


Our work to date includes chart reviews, meta-analyses as well as ethical and legal analysis.


Our papers document lesser surgical training in gynecology resulting in a prevalence of low volume surgeons and worse outcomes; disparities in reimbursement and funding in gynecology; and disparities in access to minimally invasive surgical options for women.1,2 Work most recently includes an in-depth chart review documenting a statistically significant lack of ureteral injury when gynecologic surgical training is increased.4


Disparate and inferior funding for women’s health care results in “double discrimination;” specifically lesser care for women patients and lesser pay for the women surgeons who operate. Creating equity in funding for women’s health has the potential for multiple good outcomes not least of which is higher quality care.