Physician Shortage in Relation to Compensation
Filed under: Physician Compensation, Proposed Legislation, Radiologists
The New York Times has run an article
regarding physician shortages and physician compensation that is well worth a read. The Times reports that Obama administration officials
said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans.
One proposal - to increase Medicare payments to general practitioners, at the expense of high-paid specialists - has touched off a lobbying fight.
But as the Times article does not give particulars as to physician compensation, it may be of some help to actually look at the numbers. To do so, I’ve re-posted this blog from a few months back. If, after you’ve looked at the numbers, you would like some explanation as to why they are the way they are, Professor Frank Pasquale’s post, Will Specialist Pay Be a Target of Health Care Reform?, will also serve you well. For an even further look at physician compensation, click here, and for a look at physician shortage matters click here.
Physician Compensation II
Yesterday’s post displayed recent Bureau of Labor Statistic figures concerning physician compensation, and offered a link to recent median physician compensation data approved for use by Centers for Medicare and Medicaid Services (CMS) for calculations regarding direct graduate medical education under 42 CFR 413.78(f). The producer of this data, AMGA, also offers an interactive physician compensation survey which shows “average” and “starting” compensation for various specialties. A click on the arrow underneath “average” will sort from lowest to highest.
Here below is a list of a few of the CMS approved median physician compensation figures for a number of different specialties. The numbers are taken from the 2008 report.
The median compensation for a practitioner:
- Pediatric & Adolescent, Internal 161,444
- Pediatric & Adolescent, Infect. Disease 174,154
- Family Medicine, w/out Obstetrics 176,280
- Family Med., w/out Obst., Branch* 190,182
- Geriatrics 179,344
- Podiatry: 180,080
- Transplant Surgery, Kidney 368,750
- Dermatology, Branch* 301,111
- Dermatology, Mohs 423,848
- Not neural, Non-Interventionist, Radiology 420,858
- Mammography 540,028
- Orthopedic Surgery, Spine 611,670
*Branch is defined by AMGA as: These specialties have the same basic definition as the main specialty. These physicians located in small satellite or branch offices at least five miles from the main campus. The branch office practices primarily as its own separate entity, and often has different compensation and/or performance expectations than its main campus colleagues, there would be no teaching responsibilities at these locations.
With these numbers, over the course of ten career years, if calculated at a constant rate without regard to future increases in compensation, the median paid “Family Doctor, Branch” will have earned $1,900,182. During those same static ten years, a “Mammographer” will have earned $5,400,280. If the Family Doctor were to consult with the Mammographer at the end of those ten years, she would be doing so with someone who had made $3,500,098 more than she-nearly 3 times as much. If that same Family Doctor were to then consult with someone from the lowest paid of the three categories of Radiologist, Not neural, Non-Interventionist, she would be doing so with someone who had made $4,208,580 during that time-which would be $2,308,398 more than she-or more than twice as much.
Perhaps by way of consolation for the PCP, the Geriatrics specialist and the Pediatric Infectious Disease specialist would have fared worse, and even the Kidney transplant specialist who consults with the radiologist would be speaking with someone who had made a half of a million dollars more than he did.
But perhaps it is not consolation enough; the AMA has reported that the nation faces a shortage of 35,000 to 40,000 Primary Care Physicians.
Posts from Health Reform Watch have been cited by media sources throughout the country, including The New York Times, Washington Post, L.A. Times, Kaiser Health News, The Health Care Blog, NPR's Planet Money Blog, Duke Univ. Med. Center News, American Health Line Alerts, BusinessWeek.com, Concurring Opinions, Balkinization, The New England Journal of Medicine, Harvard's Nieman Foundation for Journalism, Las Vegas Sun, Maggie Mahar, Ezra Klein, Tom Geoghegan, and the official homepage of the Office of the Democratic Majority Leader of the House of Representatives, Steny Hoyer.
This misleading, unbalanced article emits a noxious stench of political overtones.
Mammographers must put in twice the residency training time compared to a family practitioner, including a fellowship. That’s also twice as many years of low residency compensation. They have to pay more than twice as much for legal insurance and get sued well, well more than twice as often.
Its not simply a primary care shortage, its a physician shortage and a medical school shortage. Our country does not create enough physicians. There are not enough medical schools. Meanwhile, the USMLE passing score has been raised, and more medical students are being delayed or prevented from moving on to residency. If anyone thinks this is a good thing, they are wrong; these standardized tests suggest almost nothing about the future potential of the test-taker as a physician.
100’s of residency spots go vacant every year in primary care. If this situation is solved for primary care, we may concurrently find ourselves with a shortage of urologists and dermatologists (actually already in short supply). This U.S. medical education void is what allows foreign medical students to find residency spots here and work and live here thereafter.
If you were in college in this country, would you choose US Medicine over Business or Law? See the web site above for a detailed discussion on both sides of the decision.