Lure of specialist pay hurts health care

UC DAVIS (US) — 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 findings of a new study are important because they quantify wage disparities and explore 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,” says J. Paul Leigh, professor of healthcare policy and research at the University of California, Davis and the study’s lead author.

“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 study is published in the Oct. 25 issue of the Archives of Internal Medicine.

The wage differences add up to millions of dollars over a lifetime, says according to senior author Richard Kravitz, professor of internal medicine.

The result 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 says.

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, Kravitz says. The solution 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,”

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,” says 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.

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