What's ruining medicine for physicians: Imbalance in primary care versus specialist reimbursement

At the end of every year, Medical Economics publishes a list of the top challenges facing physicians. This list is generated by surveying our physician readers.

For this year’s list, we decided to recast the question. Instead of asking what challenges physicians face, our editorial staff wanted to hone in on what issues annoy and frustrate doctors and get in the way of what’s truly important: Treating patients and running practices. 

And so we asked physicians in a poll: “What ruining medicine for physicians?”

In our list of the nine issues ruining medicine for physicians, the goal is not to dwell on the negative aspects of working as a physician. Instead, we wanted to show our readers that they share common challenges when dealing with the vexing issues facing primary care in today’s complex healthcare environment. Each piece also offers practical solutions that physicians can start using in their practices today.

#8 Imbalance in primary care versus specialist reimbursement

Primary care pay has increased by more than 10 percent over the past five years, nearly double the rate of specialist compensation during the same time period, according to data from the Medical Group Management Association (MGMA). 

But even with these gains, primary care physicians earned a median income of $257,726 in 2017-compared with a median of $425,136 for specialists. 

The discrepancy in reimbursement between cognitive and procedure-based specialties has never been a secret. “Doctors don’t choose careers in primary care for the money or the lifestyle,” says Heidi Larson, MD, a consultant with Stroudwater Associates. “We choose it for the relationships with patients and their families,” says Larson, who spent the first 15 years of her career in solo family practice in Portland, Maine.

But owning and running a practice on relatively little income exacts a toll on precisely that element of practice, as physicians are forced to spend less time with more patients, she says. “It’s not just about the disparity in reimbursement. It’s about the loss of relationship and face-to-face time with our patients.”

It may not be feasible to eliminate the disparity altogether, but Larson predicts that continued movement away from fee-for-service reimbursement and toward  global payments will alleviate the strain on primary care practices. 

“We need to change the payment model to incorporate care management fees and incentives for quality, cost, and utilization. And I think that’s going to become more obvious in the coming years,” she says.

In the meantime, primary care practices can optimize their reimbursement at current rates by implementing team-based care, a staffing model in which all clinicians work to the top of their licensure, Larson says.

The MGMA report reflects an increase in team-based care by noting significant growth in compensation for non-physician practitioners. “In many communities that we visit, nurse practitioners and other advanced practice providers provide immediate care and same-day access,” says Nick Fabrizio, a principal consultant with MGMA.

When working with clients to redistribute their workload throughout an established team, Larson tracks measures such as patient experience scores, capacity and access, quality metrics, cost and utilization, and provider satisfaction before implementation of team-based care and again at three, six, and 12 months.

Success in these measures not only ensures clinicians’ and patients’ acceptance of the model, but can also help optimize reimbursement.

For example, high-performing teams can help fill gaps in care by teeing up and ordering routine health maintenance, prescription refills, smoking cessation, advanced care planning, and other items that factor into coding and reimbursement, she says.