Occupational gender segregation is a contributing factor to gender pay inequity in medicine but has not been thoroughly characterised. We assessed the historical relationship between surgeon sex, type of work and value of procedural payments. We hypothesised that female surgeons perform lower-paying procedures as a group, and that this could be seen both with broad historical overview and with focused analysis of major operative procedures in a specific year.

We conducted repeated cross-sectional studies using public payment data from the Canadian Institute for Health Information. We calculated average payment per service by sex and service category and used linear regression to assess the association between proportion of female surgeons performing a procedure and payment value per procedure for 41 major procedures in 2019–2020.

Surgeons in 10 Canadian jurisdictions from 1996 to 1997 (5459) to 2019–2020 (8069).

The proportion of female surgeons increased over the study period from 10.5% (n=575) in 1996–1997 to 28.7% (n=2314) in 2019–2020. The sex gap in the average payment per service narrowed but persisted. A greater proportion of women’s earnings came from non-procedural work in consultation and visits (43% for women vs 36% for men in 2019–2020) while a greater proportion of men’s earnings was from procedural work in major surgery (23% for women vs 38% for men in 2019–2020). There was an inverse relationship between proportion of women performing a procedure and payment value such that for one percent increase in female proportion, the procedural payment was CAD$1.77 lower.

Our findings suggest that women receive fewer procedural payments than men and tend to perform lower paying procedures. Reforms to referral systems and billing codes can help address root causes for the gender pay gap in surgery.

While group, task-oriented, community-based exercise programs (CBEPs) delivered in-person can increase exercise and social participation in people with mobility limitations, challenges with transportation, cost and human resources, threaten sustainability. A virtual delivery model may help overcome challenges with accessing and delivering in-person CBEPs. The study objective is to estimate the short-term effect of an 8-week, virtual, group, task-oriented CBEP called TIME™ (Together in Movement and Exercise) at Home compared with a waitlist control on improving everyday function in community-dwelling adults with mobility limitations.

A randomised controlled trial incorporating a type 1 effectiveness-implementation hybrid design is being conducted in four Canadian metropolitan centres. We aim to stratify 200 adults with self-reported mobility limitations by site, participation alone or with a partner, and functional mobility level, and randomise them using REDCap software to either TIME™ at Home or a waitlist control group. During TIME™ at Home classes (2 classes/week, 1.5 hours/class), two trained facilitators stream a 1-hour exercise video and facilitate social interaction prevideo and postvideo using Zoom. A registered healthcare professional at each site completes three e-visits to monitor and support implementation. Masked evaluators with physical therapy training evaluate participants and their caregivers at 0, 2 and 5 months using Zoom. The primary outcome is the change in everyday function from 0 to 2 months, measured using the physical scale of the Subjective Index of Physical and Social Outcome. The study is powered to detect an effect size of 0.4, given α=0.05, power=80% and a 15% attrition rate. Secondary outcomes are mobility, well-being, reliance on walking aids, caregiver assistance, caregiver mood, caregiver confidence in care-recipient balance and cost-effectiveness. A multimethod process evaluation is proposed to increase understanding of implementation fidelity, mechanisms of effect and contextual factors influencing the complex intervention. Qualitative data collection immediately postintervention involves interviewing approximately 16 participants and 4 caregivers from the experimental group, and 8 participants and 4 caregivers from the waitlist control group, and all healthcare professionals, and conducting focus groups with all facilitators to explore experiences during the intervention period. A directed content analysis will be undertaken to help explain the quantitative results.

TIME™ at Home has received ethics approval at all sites. Participants provide verbal informed consent. A data safety monitoring board is monitoring adverse events. We will disseminate findings through lay summaries, conference presentations, reports and journal articles.

NCT06245135.