Primary care, specialist pay gap narrowed slightly under ACA: study

Among doctors’ concerns about the 2010 Affordable Care Act (ACA) was its possible impact on their compensation, given that one of the law’s goals was to encourage development of alternatives to fee-for-service medicine. But a new study finds that physician salaries have continued to rise in the decade since the law was passed, with primary care doctors seeing slightly greater gains than specialists.

The study looks at physician pay between 2008 and 2017, using data from the Medical Group Management Association’s (MGMA) annual physician compensation survey. It finds that, after adjusting for inflation, primary care compensation increased at an annual rate of 2.2%, from a mean of $214,100 to $247,300. During the same period, specialists saw their pay increase by 1.2% annually, from a mean of $378,600 to $399,300.

The “specialist premium”—the difference in earnings between specialists and primary care providers—declined during the period from $164,500 to $152,000, or from 77% to 61%.

The study notes that the ACA included two temporary fee increases targeted at primary care physicians. The first, known as the “Medicaid bump,” raised Medicaid reimbursements during 2013-2014 to match those paid by Medicare. The second, the Primary Care Incentive Program, paid PCPs bonuses equal to 10% of their Medicare reimbursements for primary care services between 2011 and 2015.

But while helpful to PCPs, it’s not clear how much impact these increases had on the specialist premium, says Walter Hsiang, a student at the Yale School of Medicine and the study’s lead author.

“We can surmise that policies like the contributed to narrowing the gap, but there are other factors that can’t be captured in the study,” he says. Among these are the shift to value-based care models and the growth of accountable care organizations. “We know that the reimbursement changes tied to those shifts have affected primary care more than specialties, but we’re not sure to what exact degree.”

While not discussed in the study, Hsiang thinks the ACA has helped primary care doctors weather the COVID-19 pandemic. “The law is providing a reliable source of insurance for millions of Americans now [through Medicaid expansion and the health exchanges],” he says. “Without It we’d face many more people without insurance, and we know that if people don’t have insurance they’re less likely to go to the doctor.”

The study, “Trends in Compensation for Primary Care and Specialist Physicians After Implementation of the Affordable Care Act,” was published July 28 on JAMA Network Open.