Physicians News Health news for doctors and patients.
A national study of physician wages conducted by UC Davis Health System has found that specialists are paid as much as 52 percent more than primary-care doctors, even though primary-care doctors see far more patients. As efforts to implement health-care reform evolve, the study is important because it quantifies wage disparities and explores the need for wage reform to help assure a strong primary-care workforce.
“Addressing the generalist-specialist income gap is critical to increasing access to cost-effective preventive care,” said J. Paul Leigh, a professor in the UC Davis Center for Healthcare Policy and Research and lead author of the study, which is published in the Oct. 25 issue of the Archives of Internal Medicine. “There is a huge shortage of primary-care physicians, and in years to come many more of them will be needed to meet health-care reform goals.”
The wage differences add up to millions of dollars over a lifetime, according to senior author Richard Kravitz, a professor of internal medicine and investigator with the Center for Healthcare Policy and Research. The result, he said, is a critical shortfall in the number of U.S. medical students entering generalist careers, in part because of the realization that peers in specialties such as radiology and dermatology will be making more money for less work.
“There is this sense that society simply doesn’t value primary care,” he said.
For the nationwide study, the investigators compared wages of more than 6,000 doctors practicing in 41 specialties in 60 communities. The data came from the 2004 to 2005 Community Tracking Study, a periodic evaluation of physician demographic, geographic and market trends.
Unlike previous studies analyzing income disparities, the research team compared hourly wages, factoring in the hours per day physicians reported working and excluding vacation time. The 2005 hourly wages for four broad specialty categories were as follows:
– Primary care, including pediatrics, geriatrics, family practice and internal medicine: $60.48 per hour.
– Internal medicine and pediatric subspecialties, including allergy and immunology, gastrointestinal, cardiovascular, rheumatology, pulmonary, critical care, medical oncology and neonatal: $84.85 per hour.
– Other medical specialties, including radiation oncology, physical medicine and rehabilitation, emergency medicine, psychiatry, neurology, ophthalmology and dermatology: $88.08 per hour.
– Surgery, including neurological, plastic, orthopaedic and obstetrics/gynecologic: $92.10 per hour.
The specialists with the highest wages were neurological surgeons, radiation and medical oncologists, dermatologists, orthopaedic surgeons and ophthalmologists. In general, physicians who earned the most money either performed surgery, deployed sophisticated technologies or administered expensive drugs in office settings. Lower-paid specialties primarily relied on talking with and examining patients.
An over-reliance on highly specialized medicine results in skyrocketing costs as well as poorer overall health, as prevention and primary medical care are de-emphasized, according to Kravitz. The solution, he said, lies in reducing the wage disparities and redesigning the payment structure for care.
“Instead of rewarding the use of expensive and often risky procedures, greater emphasis should be placed on getting the basics right — immunizations, cancer screenings, chronic-disease management and recognition of the ‘red flags’ that signal the need for more intensive diagnostic study,” said Kravitz.
The authors point out that a shortage of primary-care doctors will be especially worrisome as the baby-boom generation ages.
“Given the central role of generalists in caring for older patients with complex, chronic illnesses, these findings could predict future problems with meeting the medical needs of our growing population of elderly patients,” said Leigh.
Additional study outcomes revealed no significant differences in wages by race, indicating that medicine may have achieved wage parity for minorities. Wages for women, however, were $9 less per hour regardless of practice area, indicating that gender parity in physician wages has yet to be achieved.
From PND Wire Services
As a young primary care doctor, I find the comments above completely misinformed. While I agree that a crucial way to encourage more students to enter generalist fields is to reduce the cost of medical education in this country, I resent the comparison of primary care doctors to ‘preschool teachers.’ We went to medical school right alongside all of the specialists, and having a few years less in residency does not make the difference between a preschool teacher and a doctoral professor. We may not use lasers to blast kidney stones or interpret PET scan results, etc, but we face diagnostic challenges on a daily basis and rely on our ability to think broadly and widely about our patients and their differentials. This is something many specialists will readily claim that they lost once they found their niche field. Medicine is not all about procedures and cutting-edge science. The art is equally important, but because it is intangible and no longer respected that it goes uncompensated. All we ask for is that we be reimbursed fairly for the skills that we use to keep our patients as healthy as possible. You may not always appreciate this, but our patients surely do.
The reality is that primary care doctors do the work that nobody else has the patience to do. Without respecting and building strong relationships with their generalist colleagues, specialists would have no source of patients. Please consider this before making derogatory statements such as this on a public forum.
I 100% agree with “specialist” above.
Also, if specialists do not get paid more, where is the incentive to go to the extra school and work to become a specialists? There is none. Result: there are no specialists in the country, and more people die.
Also, this survey did not talk about ANNUAL wedges. It may be the case that while specialist get paid more per hour, there are less hours that a specialist can work, due to lack of demand. This would even out the pay between specialist and primary care doctors (if this is the case).
Also, usually the specialists have jobs that are more intense and more complicated. Thus deserving higher pay.
Kravitz’s argument says that we should pay a preschool teacher the same as professor in a doctorate program.
The fundamental problem with studies like these is the conclusions that are drawn. Yes, primary care doctors get paid less than specialists, but increasing primary care pay is not the answer to increase access. Why would you pay a primary care physician more money to do something that a skilled nurse or physician’s assistant can do for much, much, less.
The reality is that primary care is not that difficult. They are possibly overpaid, and certainly should not be making more money than they are now.
The bigger barrier to access is not physician reimbursement, but the cost of medical school. The AVERAGE medical school bill for 4 years including room and board is now in the 250k – 300k range. Combine these suffocating loans with ever-increasing malpractice insurance, and overhead, and unfunded regulatory mandates, and you get crisis.