Primary care compensation increasing, but has far to go to reach specialist levels

If you are a primary care physician (PCP), the good news is that your median compensation probably increased from 2009 to 2010. The bad news is that you still are making substantially less-sometimes less than half as much-as some of the higher-paid medical specialties.

The Medical Group Management Association’s (MGMA's) 2011 Physician Compensation and Production Survey said that internal medicine physicians saw their compensation rise more than 4% to a median of $205,379 with a nearly 3% increase for family practice (without OB services), at a median pay of $189,402.

On the other hand, orthopedic surgeons had a median compensation of $514,659, representing a 3.71% increase during that time period.

Where you live also affects your pay compared to specialty physicians. The MGMA survey found that specialists out-earned primary care physicians by nearly 190% in the South in 2010.  Compensation was closest in the East, where specialists brought home just under 160% of PCPs.

That adds up and medical students are well aware of the disparities in earning potential.

PCPs earn $3.5 million less in total lifetime income than subspecialists, according to a report sponsored by the American Academy of Family Physicians (AAFP), driving medical students to shun general internal medicine, family practice, and other primary care fields.  Medical students today are half as likely to choose primary care as they were 30 years ago and are 20% less likely to practice in a rural area.

Already, rural and low-income communities are hard hit by the shortage of PCPs, which the Institute of Medicine (IOM) estimates exceeds 16,000-and the problem is likely to become more acute with the implementation of the Affordable Care Act.

To increase parity between specialists and PCPs and address the growing shortage of PCPs, the AAFP called on the relative value scale update committee (RUC) to change its structure to give greater representation to primary care fields.

AAFP chair Lori Heim, MD, asked the RUC to change its composition by adding four seats to the board for PCPs-one each for the AAFP, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association-and eliminating three rotating subspecialty seats. The June letter suggested an additional four seats, three for external representatives such as consumers or health plans, and one for Geriatrics. The RUC currently has 29 members.

The RUC was formed by the American Medical Association to advise the Center for Medicaid and Medicare Services (CMS) on the relative value of physician services. CMS uses the recommendations to determine physician payments for specific codes. As many private health plans follow CMS’ lead on payments, the RUC’s recommendations have a tremendous potential impact on physician earnings.

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