Government health insurers overpay specialists compared to primary care doctors and "exacerbate the shortage of primary care physicians," according to a study by Harvard Medical School researchers at the Cambridge Health Alliance.
The authors found that among the four medical specialties which derive more than half of revenues from government sources - geriatrics, hematology-oncology, nephrology and rheumatology - incomes can be more than triple that of a primary care physician's income.
"The average cardiologist makes about as much from Medicare - which accounts for less than half of his or her practice - as the entire income of a geriatrician, who spends full time caring for elderly Medicare patients," said study co-author Dr. Steffie Woolhandler, a primary care physician at Cambridge Health Alliance and an associate professor of medicine at Harvard Medical School. "Politicians like to bemoan the shortage of primary care doctors, but their policies are creating that shortage."
For example, the study found that geriatricians' incomes averaged $165,000 annually, as opposed to $504,000 for hematologists, though the two specialties require a similar amount of training.
In total, Medicare accounts for 21.1 percent of payments to doctors, Medicaid for 6.8 percent and other government programs for 3.2 percent.
The study, which analyzed the Medical Expenditure Panel Survey, was released online by the Journal of General Internal Medicine, and will be published in the September 2008 print issue.
Officials said the data underestimates the extent to which government sources contribute to physician revenue, as nursing home residents (most of whom have Medicare and/or Medicaid), active duty military personnel and prisoners are not surveyed.
"It's no surprise that there is a shortage of primary care doctors when debt-burdened medical students have much more lucrative career options. What is surprising is that government fee schedules are behind much of this income discrepancy," said lead author Dr. Karen Lasser, a primary care physician at Cambridge Health Alliance and an assistant professor of medicine at Harvard Medical School
Was your practice part of this study? Send your comments to Associate Editor Chelsey Ledue at chelsey.ledue@medtechpublishing.com.