What Happened to All the Primary Care Physicians?
SpreeHealth
0 Comments
Demand for primary care doctors is at an all-time high. Experts in the industry believe that this demand is due to a variety of factors, including the Affordable Care Act’s focus on primary care and preventive medicine and the fact that a good number of primary care physicians are reaching retirement age at the same time that med-school graduates are choosing to specialize, instead.
But there’s another compelling reason, too. Study just about any healthcare salary chart and you’ll see that it’s sad but true: Primary care physicians are always listed at or near the bottom. For instance, a recent salary survey showed the median income for family medicine physicians in the U.S. is around $193,500 (and only $192,000 for internal medicine physicians), compared to $224,000 for neurologists, $250,000 for dermatologists and $340,000 for cardiologists.
So we decided to find out: Why aren’t more med students choosing to become primary care physicians? Is it solely because of the relatively low salary, or are there other contributing factors? We asked Tyler Friedrich, M.D., a hospitalist in Denver, his thoughts on the subject:
What are the reasons for the disparity in salaries between primary care docs and other specialists?
Dr. Friedrich: While there is an argument to be made for pay being tied to length of training — cardiologists, orthopedists and other highly paid specialists usually spend six to seven years or more in residency, versus three for primary care — the difference in pay is not in proportion to this at all. I think it’s partly because, under our current healthcare model, there is no way to bill accurately for preventive care. Despite physicals and other such visits taking much longer than, say, a skin biopsy, they’re only reimbursed a fraction of the amount of procedures like that. Until our healthcare system catches up with the rest of the developed world in terms of incentivizing preventive health, I’m afraid this isn’t going to change.
And that’s why more and more med students are choosing to specialize?
Dr. Friedrich: Yes, that’s what I’ve noticed. While $185,000 is a very nice annual salary, if you have med-school loans to pay off, the higher-paying specialties are definitely more attractive. I also think vanity and prestige contribute to this. I’ve been asked many times, “Don’t you want to specialize?” — as though this should be the default aspiration. The people I knew in med school who wanted to go into primary care — only two or three in my 100-person class — were definitely a more compassionate breed, seemingly uninterested in the money and high profile that were drawing the rest of the class toward specialties.
How do physician assistants and nurse practitioners figure into this?
Dr. Friedrich: The emergence of advanced-practice providers (APPs) such as PAs and NPs is a bit of a double-edged sword in primary care. Primary care providers are definitely over-extended, given the shortage, frequently seeing more than 20 patients per day. APPs can help offset the workload, for sure. The issue is that they provide a cheaper alternative for healthcare organizations, salary-wise, and this decreases any leverage the physicians might have to try and close the pay gap. Plus, APPs usually get to see the more straightforward, healthy patients, such as well-woman or well-child visits, leaving the doctors with the more complicated cases that take a lot longer than their scheduled appointment time.
You’re saying, then, that primary care physicians are over-worked? Is that also contributing to the shortage?
Dr. Friedrich: Absolutely. Concentrating the more complicated cases on a primary care physician’s schedule while still expecting them to churn out the same number of patient visits in a day is only going to further the over-worked, burned-out physician problem. The best primary care physician is someone who spends a good deal of time counseling patients about their health, and they can’t really take time to do that effectively if their schedule is tightly packed. Preventive health is extremely important from a population health standpoint, but it’s not compensated fairly.
So, what’s the solution then?
Dr. Friedrich: Closing the pay gap between primary care physicians and specialists, and fixing our healthcare system!
