Primary-care physicians averaged as much as $2.8 million less than specialists, potentially making primary care a less attractive choice for medical school graduates and exacerbating the already significant shortage of medical generalists, a study found.
The results, published online in the journal Medical Care, lead the study's authors to recommend reducing disparities in physician pay to ensure adequate access to primary care.
"The need for primary-care providers is greater than ever before and expected to grow as millions more Americans become insured under the Affordable Care Act," the lead researcher said in a press release. "Without a better payment structure, there will be extraordinary demands on an already scarce resource."
After adjusting for covariats that also affect earnings, the researchers evaluated incomes for more than 6,000 doctors in 41 specialties. When merged into four broad career categories, lifetime earnings in surgery, internal medicine and pediatric subspecialties, and all other medical specialties averaged from $761,402 to $1,587,722 higher than in primary care:
* surgery: $4,588,249
* internal medicine subspecialties and pediatric subspecialties: $4,100,183
* all other medical specialties: $3,761,930
* primary care (geriatrics, family practice, general practice, general internal medicine and general pediatrics): $3,000,527
The earnings differences were more dramatic when compared as 41 separate specialties, according to the press release. Medical oncologists, for instance, earn up to $7,127,543 during a 35-year career, while family medicine practitioners earn as low as $2,838,637.
Richard Kravitz, MD, FACP, one of the study's authors who serves on an independent commission to assess physician pay, said, "These huge lifetime pay disparities have to be discouraging for medical students considering primary care as a career If we truly value primary care, we need payment schemes that don't send the opposite message."
The study is a follow-up to research in 2010 on differences in annual wages by specialty. Researchers compared lifetime earnings to demonstrate how annual wage differences accumulate over physicians' careers. The earnings data came from the 2004-2005 Community Tracking Study, a periodic evaluation of physician demographic, geographic and market trends.