October 26, 2010

Primary Care Doctors Make Less Than Specialists

According to a new study of doctor salaries, specialty physicians - such as surgeons and oncologists - can earn twice as much as primary care physicians.

Authors of the study suggest that this wage gap could be contributing to the current shortage of primary care doctors in the United States, as well as driving the rising costs in health care.

Unlike in the US, most other countries generally have more primary care doctors than specialty doctors, lead researcher J. Paul Leigh, of the University of California Davis School of Medicine, told Reuters Health by email.

"That can be changed if we could just change the salaries, and let medical students know about it so they don't pursue these specialties so aggressively," he said.

Studies of physician wages in the past looked only at annual salaries, which did not take into account how many hours a doctor actually worked in a week or the number of weeks worked in a year.

To get a better picture of how wages differ among a variety of practices, Leigh and colleagues collected detailed information from more than 6,000 practicing doctors in 2004 and 2005. They measured both annual and hourly earnings.

The team found that doctors earned, on average, an annual income of $187,857. The average hours worked per week was 53 and weeks worked in a year was 47. The annual earnings, however, varied greatly across the spectrum of special practices, with the lowest wages -- averaging $60.48 per hour -- paid to primary care physicians.

Surgeons took home the highest average hourly wage of $92.00. Internal medicine and pediatric care physicians earned an average of $85 per hour, the researchers reported.

Looking at 41 specific subspecialties, however, the team found that neurological surgery and radiation oncology was the most lucrative at $132 and $126 respectively. Medical oncologists and plastic surgeons raked in about $114 per hour, while immunologists, orthopedic surgeons and dermatologists made more than $100 per hour. Child psychiatrists and infectious disease specialists were at the low end of the specialty ladder, earning a mere $67 per hour.

The team also found a gender salary gap, with women earning an average of $9 less per hour than men.

But it isn't just physicians who "are looking at this disparity and choosing higher wages," said Leigh. "The economic incentives for medical schools and their students have been out of whack. Schools understand that a cardiac unit is going to bring in more money than a family practice unit."

"Especially now that our costs for medical care are soaring, we need to get these disparities under control," added Leigh. "And the government can. We don't have a free market of supply and demand operating for physicians, rather it's highly regulated by Medicare."

Proposals in health care reform laws are looking for ways to increase wages for primary care physicians, Leigh said. But that may not be enough. He suggests cutting wages of specialists too.

It's not just primary care doctors who are "undervalued by society," said Leigh, "but the specialist is overvalued and overcompensated, while not really adding much bang for the buck as far as public health is concerned."

Referring to some 15 million uninsured people around the country who will be brought into the health insurance system when reform laws go into effect, Leigh noted: "the first contact for most of these people should be a primary care physician."

But with the current, and growing, shortage of primary care physicians, it is making it hard for doctors to take on new patients, he said.

About 80 percent of physicians support raising primary care pay, yet fewer than 40 percent support a 3-percent reduction in specialist pay to offset that increase.


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