As America continues to debate Affirmative Action and equal pay issues, a new study shows medicine men outearn women by 88 percent for services covered by Medicare, the nation’s largest health insurer.

Among physicians of all specialities, the average man earned $118,782 per year from the government health program for the elderly and disabled, compared to $63,346 for women — a major part of their overall compensation. Men saw 60 percent more Medicare patients at 513 per year compared to 320 for men. They also performed more procedures on each patient, at 5.7 services per patient compared to 4.7 services performed by women in the profession.

Suzanne Koven, an internal medicine specialist, says the pay gap between men and women emerges regardless of a woman’s choices along the mommy track. “There’s a gender gap between male and female physicians’ salaries and, as this JAMA article suggests," she said, "the difference isn’t entirely due to specialty choice or decisions to work part- time (sic) during childrearing. Even adjusting for these factors, men make an average of $12,000 more than their female medical colleagues.”

Researchers from Duke University and several other U.S. institutions found last year that “gender differences in salary exist in this select, homogenous cohort of mid-career academic physicians, even after adjustment for differences in speciality, institutional characteristics, academic productivity, academic rank, work hours, and other factors.” After adjusting for all of these factors, study leader Reshma Jagsi said men earned a median salary — including Medicare payments — of $200,433 compared to $176,922 for women.

With all else equal, the quality of male gender was worth $12,194 in annual income. Aside from possible sexism, the pay disparity suggests a larger issue with Medicare, the researchers from NerdWallet Health said.

“Because Medicare pays through a fee-for-service system, doctors have a financial incentive to provide more services. More services means patients incur additional costs. These costs are both financial, in the form of additional copayments, as well as medical, in the form of increased exposure to a health care system in which over 210,000 patients die annually from medical errors.”

Source: Jagsi R, Griffith KA, Stewart A, et al. Gender Differences In The Salaries Of Physician Researchers. JAMA. 2013.