Category: Physician Income

UC Prof. Warns of Health Care System Crisis

UC Prof. Warns of Health Care System Crisis:

“While the incomes of primary care physicians are by no means meager, the discrepancy in comparison to specialists has become large enough to ‘discourage medical school graduates from choosing primary care careers,’ Bodenheimer wrote in the article. “

It’s worth looking back at Gawande’s article, “Piecework,” for more on this…

AMNews: Oct. 24/31, 2005. Canadian tide turns as residents return home … American Medical News

AMNews: Oct. 24/31, 2005. Canadian tide turns as residents return home … American Medical News

Experts say an improving climate for physicians in Canada and an increasingly hostile one in the United States are driving the change.
By Myrle Croasdale, AMNews staff. Oct. 24/31, 2005.
Deepening administrative burdens from managed care insurers and rising medical liability rates are some of the reasons more of Dr. Warner’s Canadian colleagues are returning home after training or practicing in the United States.
The shift also is attributed to the Canadian government’s efforts to reinvest in upgrades, such as new operating rooms, under the single-payer system. In some provinces, physicians are being offered higher reimbursements. All of this is to stem a growing shortage of doctors and increase access to quality care. Such stability follows deep cutbacks in Canada’s reimbursement and health care infrastructure during the 1980s and 1990s.
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Recent surveys from the Medical Group Management Assn. showed that physician pay is flat or declining in many specialties. Canadian salary figures were not available at press time, although CIHI data indicate that Canadian physicians have average billings about 25% less than their U.S. colleagues.
But doctors in Canada do not have the paperwork of multiple insurers or the steep increases in liability insurance premiums. In Ontario, considered a high-risk province, an ob-gyn would pay the equivalent of $65,000 for coverage, while in Florida, also considered high-risk, insurance would cost $277,000. Liability costs are increasing in Canada, though they’re blunted by a tort-based compensation system, with compensation limited to cases in which fault is proven or settlement is made.

A comparison of the educational costs and incomes of physicians and other professionals. [Entrez PubMed]

Entrez PubMed Link
N Engl J Med. 1994 May 5;330(18):1280-6.
Comment in:
N Engl J Med. 1994 May 5;330(18):1311-2.
A comparison of the educational costs and incomes of physicians and other professionals.
Weeks WB,
Wallace AE,
Wallace MM,
Welch HG.
Veterans Affairs Outcomes Group, Veterans Affairs Medical Center, White River Junction, VT 05009.
BACKGROUND. Efforts at physician-payment reform in the United States have focused largely on the relative incomes of primary care physicians and specialists, who more often have procedure-based practices. Comparisons of the incomes of physicians and other professional groups have received less attention. METHODS. We used standard financial techniques to determine the return on educational investment over a working lifetime for five groups of professionals: primary care physicians, specialist physicians, dentists, attorneys, and graduates of business schools. RESULTS. In current dollars, the difference in the average future hourly income between a given professional and a high-school graduate of the same age, after educational expenses are subtracted (average hours-adjusted net present value of the educational investment) was greatest for specialist physicians and attorneys; dentists and businesspeople had intermediate values; and primary care physicians had the lowest value. The annual yield on the educational investment over a working life (hours-adjusted internal rate of return) was 15.9 percent for primary care physicians, as compared with 29.0 percent for businesspeople, 25.4 percent for attorneys, 20.9 percent for specialist physicians, and 20.7 percent for dentists. A sensitivity analysis showed that primary care physicians did less well in terms of the return on investment than the other groups even when we varied the assumptions in our model widely and that specialist physicians did less well than attorneys working in law firms and dental specialists. CONCLUSIONS. Students can expect a poorer financial return on their educational investment when they choose a career in primary care medicine than when they choose a procedure-based medical or surgical specialty, business, the law, or dentistry.
PMID: 8145784 [PubMed – indexed for MEDLINE

Long-term financial implications of specialty training for physicians. [Entrez PubMed]

Entrez PubMed
Am J Med. 2002 Oct 1;113(5):393-9.
Links
Long-term financial implications of specialty training for physicians.
Weeks WB,
Wallace AE.
Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire, USA. william.b.weeks@dartmouth.edu
PURPOSE: Given the recent changes in physician reimbursement and managed care penetration, we examined the financial returns that might be anticipated when considering different medical careers. METHODS: We used survey data from the American Medical Association and standard financial techniques to calculate the return on educational investment (as the discounted, annual hours-adjusted, net present value of additional training) over a working lifetime for six different specialties (family practice, pediatrics, general internal medicine, gastroenterology, cardiology, and general surgery). RESULTS: From 1992 to 1998, the annual yield on specialty training (hours-adjusted internal rate of return) declined for all specialty groups, especially for primary care specialties. The difference in the average income between a given specialty and general practice decreased for general internal medicine, from $5400 (95% confidence interval [CI]: $5000 to $5800) in 1992 to $1180 (95% CI: $1160 to $1205) in 1998, and became negative for family practice (from $5200 [95% CI: $1000 to $9500] to -$2500 [95% CI: -$5800 to $800]) and pediatrics (from $4000 [95% CI: $1200 to $6800] to -$6300 [95% CI: -$9700 to -$2900]). Values for surgery decreased from $33,100 (95% CI: $29,400 to $36,400) in 1992 to $27,200 (95% CI: $21,700 to $32,100) in 1998, whereas there were increases for cardiology, from $35,100 (95% CI: $30,000 to $39,700) to $36,700 (95% CI: $26,500 to $45,700), and for gastroenterology, from $30,000 (95% CI: $21,800 to $37,200) to $34,700 (95% CI: $22,700 to $45,300). CONCLUSION: Our analysis suggests that recent efforts to use financial incentives to make primary care fields more attractive have not been effective. Financial returns and the incentives they create should be carefully considered as part of health care reform.
PMID: 12401534 [PubMed – indexed for MEDLINE]

“Is everyone as tired as I am?” The CMA’s physician survey results, 1999 — Martin 161 (8): 1020 — Canadian Medical Association Journal

“Is everyone as tired as I am?” The CMA’s physician survey results, 1999 — Martin 161 (8): 1020 — Canadian Medical Association Journal