Primary care doctors seem to be getting the short end of the stick, making significantly lower wages than specialists, according to new research published Monday in the Archives of Internal Medicine. These significant disparities may hinder health care reform by weakening the primary care workforce, the researchers said.
"We thought this might be interesting for medical students to understand what the weight is of specialties," Paul Leigh, lead researcher and professor at the University of California Davis School of Medicine, told DOTmed News.
The researchers studied data from 6,381 physicians from 2004 to 2005, comparing wages across four broad specialties, including primary care, surgery, internal medicine, pediatric subspecialties and 'other.' They examined wages among 41 specific specialties along with differences based on demographic, geographic and market variables.
This study, said Leigh, an economist, is unique in that it is the first to examine physicians' wages.
The study found that overall, clinicians earned an average annual income of $187,857 and worked an average of 53.1 hours per week. When compared to those of a primary care specialist, wages were 48 percent higher among surgeons, 36 percent higher among internal medicine and pediatric subspecialists and 45 percent higher among clinicians in other specialties, according to the report.
Looking at the 41 specific specialties, the researchers found that neurologic surgeons - $132 per hour - and radiation oncologists - $126 per hour - earned the highest wages. The lowest wages? Internal medicine specialists and pediatrics with $50 an hour and other pediatric subspecialists with $52 an hour.
When compared with the reference group of general surgeons, whose wages were close to the median of $86, wages were "significantly lower" for internal medicine and pediatrics combined - $24 less - and internal medicine, family medicine and other pediatric subspecialties at $24, $24 and $23 less, respectively. The research also found that physicians in neurologic surgery, radiation and medical oncology, dermatology, orthopedic surgery and ophthalmology all earned $17 to $50 more per hour than general surgeons.
"I thought primary care [wages] would be less," said Leigh. "But I didn't know it'd be quite that great of a disparity."
One factor that may be cause for the significantly lower wages of primary care doctors is the reimbursements from Medicare, said Leigh. Private insurers tend to follow Medicare's lead, making the lower wages more universal.
"The system of payment is not established by demand and supply, but by government-established prices," said Leigh. "The key thing here is that the government can then change those prices."
He explained that the government will determine how much a physician should be paid for, say, a colonoscopy.
"People respond to incentives," he said. "If people get paid more for procedures, they say, 'Let's do more.'"
Although wage disparity was found between men and women, Leigh and his team reported that there was no disparity due to race or ethnicity.
"We're happy about that," he said. "We were one of the first to show that."
The researchers did not study whether a white female would be paid more than a minority female.
The research confirms Leigh's suspicions that specialists are overpaid - a problem that will only help cause health care costs to skyrocket, he said.
"Specialists are overvalued, they're overpaid," he said. "These days we're concerned about medical costs, and one way to bring them down is to reduce hours and wages for specialists. Why must we pay specialists $150 an hour?"
The implications of these findings are disconcerting, as medical students choose specialties that will pay them better wages in a time when the primary care workforce is facing and will continue to face a severe shortage.
"[The shortage] is exacerbated by these differentials," Leigh said.
"[With health care reform], we're going to bring in more patients and where are the primary care doctors for them?" asked Leigh. "There will be a big logjam in the next couple of years. Students in med school are not dumb. They're looking at the expected future wages for different specialties, and they see primary care at the very bottom...It's not surprising to me that a lot will choose to become specialists."