The trend of primary care physicians earning lower wages for their services compared to specialists is not tied to the number of hours they work, according to research published in the Archives of Internal Medicine last month.
Written by J. Paul Leigh, PhD, and colleagues, the research letter in AIM looks at the number of hours physicians work in comparison to what they earn.
“I was surprised by the primary care physician results,” said Leigh, professor of public health sciences at the University of California, Davis. “I kind of anticipated that their annual work hours were going to be very low, but they weren’t. They were in the middle of the group… That was surprising. I thought that they would be toward the low end.”
Leigh and his colleagues looked at a nationally representative sample of physicians from the 2004-2005 Community Tracking Survey. Their sample contained 6,381 physicians self-reporting 20 to 100 weekly work hours and at least 26 weeks worked annually. The sample did not include radiologists, anesthesiologists or pathologists and did not account for variability across day, swing or night shifts or for weekends, holidays or hours-on-call. The researchers analyzed 41 specialties with at least 20 respondents and the broad-specialty categories of primary care, surgery, internal medicine, pediatric specialties and other specialties. The mean annual hours worked was 2,524.
Connecting their hours research to earlier research they’d done on physician pay, the researchers found that primary care physicians – pediatricians, family practitioners and internal medicine specialists – worked hours in the middle range but earned wages on the lower end of the income scale. Most specialty physicians, like vascular surgeons, logged in long hours and were paid on the high end of the wage scale, but some physicians in specialties like dermatology, put in fewer hours but still earned high wages.
That primary care physicians are earning less and yet are not working a significant amount less than their higher earning counterparts is troubling, said Leigh.
As medical students weigh which fields they will practice, they look at wages and lifestyle issues, Leigh noted. “If your work hours are the same and your earnings are very much lower than the other specialists then you’re going to have a lot of medical students choosing the specialties,” he said. Additionally, as current primary care physicians are squeezed economically, they are leaving their practices.
“Primary care physicians feel like they’ve been given the shaft (on reimbursement) for a long time,” he said. Policy makers need to fix the physician payment disparities, he added, suggesting that changes to the physician payment system can be made incrementally and that primary care physicians should have more of a voice in determining pay reimbursement.
[See also: AAFP seeks changes from the RUC.]
“Let’s make some adjustments here and try to be more reasonable about reimbursements in light of what their income is and also, of course, in light of what the hours are, because physicians are going to be concerned not just with the pay but with the hours of work,” he said.