Do specialist doctors make too much money?

NEW YORK (Reuters Health) - Primary care physicians earn as little as half what their colleagues who specialize in areas such as surgery and oncology are taking home, according to a new study of doctors’ salaries.

The study’s authors suggest that this wage gap might be contributing to the current shortage of general-practice doctors in the U.S., as well as driving the nation’s rising costs of medical care.

“In other countries, there are typically more primary care than specialty doctors. But here it is the opposite,” lead researcher J. Paul Leigh, of the University of California Davis School of Medicine, told Reuters Health in an e-mail. “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.”

Prior studies of physician wages looked only at annual salaries, which do not take into account how many hours a doctor puts in per week or the number of weeks worked per year.

To get a clearer picture of how wages -- measured both annually and hourly -- differ among a variety of general and specialty practices, Leigh and his colleagues collected detailed information from more than 6,000 practicing doctors in 2004 and 2005.

Overall, the team found that doctors earned an average annual income of $187,857, working about 53 hours per week and 47 weeks per year. This compensation, however, varied widely across specialties, with the lowest wages -- amounting to $60.48 an hour -- paid to primary care physicians.

In other broad categories of practice, surgeons took home the highest average hourly wage of $92. Internal medicine and pediatric docs earned about $85 an hour, the researchers report in the Archives of Internal Medicine.

Looking at salaries among 41 specific subspecialties, however, they found neurologic surgery and radiation oncology to be the most lucrative at $132 and $126 per hour, respectively. These were followed by medical oncologists and plastic surgeons, both making around $114 per hour; immunologists, orthopedic surgeons and dermatologists also took in more than $100 an hour. At the low end of specialist pay, child psychiatrists and infectious disease specialists made around $67 an hour.

The disparities held after accounting for age, race, sex and region of the country.

Further, the researchers found no evidence of salary disparities between racial groups. However, a gender salary gap remained, with women earning an average of $9 less per hour.

“It’s not just doctors themselves that are looking at this disparity and choosing higher wages,” said Leigh, a healthcare policy researcher. “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.”

Some of the proposed health care reform laws would increase wages for primary care physicians, noted Leigh. But he doesn’t think that is enough. He suggests cutting wages of specialists too.

“Not only are primary care physicians undervalued by society,” Leigh said, “but the specialist is overvalued and overcompensated, while not really adding much bang for the buck as far as public health is concerned.”

He noted that specialists tend to use the most high-tech medicine, which is “costly and questionable a lot of the time.”

Leigh also pointed to some 15 million uninsured people across the U.S. who will be brought into the system when the new reform laws go into effect.

“The first contact for most of these people should be a primary care physician,” he said. “But the shortage has made it increasingly hard for these doctors to take on new patients, creating a bottleneck.”

In a separate study published in the same issue of the journal, researchers from the Mount Sinai School of Medicine in New York surveyed physicians’ opinions on various reform options and found that while most agreed that Medicare reimbursement is flawed, they disagreed on the best way to fix it.

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

SOURCE: Archives of Internal Medicine, online October 25, 2010.