Primary Care Physician Shortage Linked to Lower Income
In primary care, salaries were lower than in other specialties and residency slots were less likely to be filled, Mark Ebell, M.D., of the University of Georgia, reported in the Sept. 9 issue of the Journal of the American Medical Association.
And the average debt for a medical school graduate has quadrupled — going from $35,000 to $140,000 — in the nearly 20 years since Dr. Ebell first studied salary disparities. In a 1989 study, Dr. Ebell described a linear correlation between the median income of physicians in a specialty and the percentage of residency positions for that specialty filled by U.S. medical school graduates.
Since that time, decreasing numbers of U.S. graduates are choosing primary care (family medicine, pediatrics, and general internal medicine), and the income disparity between primary care and other specialties has grown.
The number of U.S. graduates entering family practice residencies, for instance, has dropped by 50%.
Meanwhile, student debt has risen to a median of $140,000 for the class of 2007.
Dr. Ebell’s current study examined whether there is an association between specialty selection and anticipated incomes using current data.
Residency information came from the National Residency Match Program; mean annual salary in 2007 came from the annual American Medical Group Association survey of physician salaries.
The analysis was limited to specialties offering at least 100 postgraduate year-one positions.
There was a strong correlation between higher overall salary and higher fill rates with U.S. graduates (r=0.82, P=0.001).
Boys and girls, this is not rocket surgery or brain science. Fourth year medical students make career decisions based on many factors, and money may be the most important factor. I hate that money is that important, but it really is.
Our health care payment mess induces students to make career decisions using the wrong parameters.
Back in the 1970s, when I was a medical student and resident, internal medicine was the most competitive field, and fields like dermatology, radiology, anesthesiology and orthopedics [the ROAD] were easy to enter. What happened to change this – Medicare and especially the RUC. Our payment structure has no rationale. CMS pays for episodes in a rather arbitrary manner. They have not thought through the implications of how physicians are paid.
“Democracy is a device that insures we shall be governed no better than we deserve.” – George Bernard Shaw
I do not think that quote applies to the payment problems, but maybe it does. We need a radical change in physician payment, one that we upset many specialists and subspecialists. We need that change for the health of our patients. Who will have the courage to make such changes? Do you see any bravery in the political arena? Do you imagine any bravery at CMS?
