PCP, specialist pay disparity highlighted in new study

Both the need for and shortage of primary care physicians (PCPs) are expected to increase in the coming years as more Americans become insured under the Affordable Care Act, yet attracting new PCPs also may prove to be increasingly difficult in light of a new study that places their lifetime earnings well below those of their specialist colleagues.

According to a national study out of the University of California-Davis Center for Healthcare Policy and Research (UC-Davis), PCPs (which the researchers defined as including geriatrics, family practice, general practice, general internal medicine, and general pediatrics) earn roughly $3 million over the life of their career. In contrast, all other medical specialties averaged $3.7 million in lifetime earnings, with internal medicine subspecialties and pediatric subspecialties earning about $4.1 million. The lifetime earnings for surgeons averaged nearly $4.6 million, whereas medical oncologists earned up to $7.1 million over a 35-year career, the report concluded. That is a stark contrast to the low-end lifetime wages for a family practitioner of $2.8 million.

“These huge lifetime pay disparities have to be discouraging for medical students considering primary care as a career,” says the study’s senior author, Richard Kravitz, MD, a UC-Davis professor who also serves on an independent commission to assess physician pay. “If we truly value primary care, we need payment schemes that don’t send the opposite message.”

The earnings data for the study were taken from the 2004-2005 Community Tracking Study, a periodic evaluation of physician demographic, geographic, and market trends. The data were adjusted to account for age, sex, race, board certification, graduation from foreign medical schools, rural residence, and other factors that could affect earnings. Incomes for 6,000 physicians in 41 specialties were analyzed.

Overall, average lifetime earnings in all other specialties ranged from $761,402 to $1.58 million higher than primary care.

Lead author J. Paul Leigh, PhD, a professor of public health sciences and researcher with the UC-Davis Center for Healthcare Policy and Research, says in the study that one reason for the disparity in earnings could be the tendency for Medicare administrators to use recommendations from an American Medical Association committee on physician pay that prices specialist procedures “far higher” that primary care office visits. Private insurance companies, in turn, tend to adopt Medicare pay rates, he says.

“The need for primary care providers is greater than ever before and expected to grow as millions more Americans become insured under the [ACA],” Leigh says. “Without a better payment structure, there will be extraordinary demands on an already scarce resource.”

The study, “Lifetime earnings for physicians across specialties,” was published online and will be published in the December issue of the journal Medical Care.

In another study from researchers at Albert Einstein College of Medicine of Yeshiva University, the Brody School of Medicine at East Carolina University, and North Carolina State University, medical students who anticipated higher levels of debt on graduation and placed a premium on higher incomes were more likely to enter a high-paying medical specialty. Among the 2,500 medical students surveyed over an 18-year period from 1999 to 2010, 30% of students who entered medical school intending to pursue careers as PCPs switched their preferences to specialties by the time they graduated. Those students who switched placed more emphasis on higher salaries and expected a debt load 11% greater than students who chose primary care careers.

The paper, titled ““Payback time: The association of debt and income with medical student career choice,” was published online in the October issue of Medical Education.

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