Article

The Primary Care–Specialty Income Gap: Why It Matters

University of California, San Francisco, San Francisco, California, USA.
Annals of internal medicine (Impact Factor: 17.81). 03/2007; 146(4):301-6. DOI: 10.7326/0003-4819-146-4-200702200-00011
Source: PubMed
ABSTRACT
A large, widening gap exists between the incomes of primary care physicians and those of many specialists. This disparity is important because noncompetitive primary care incomes discourage medical school graduates from choosing primary care careers. The Resource-Based Relative Value Scale, designed to reduce the inequality between fees for office visits and payment for procedures, failed to prevent the widening primary care-specialty income gap for 4 reasons: 1) The volume of diagnostic and imaging procedures has increased far more rapidly than the volume of office visits, which benefits specialists who perform those procedures; 2) the process of updating fees every 5 years is heavily influenced by the Relative Value Scale Update Committee, which is composed mainly of specialists; 3) Medicare's formula for controlling physician payments penalizes primary care physicians; and 4) private insurers tend to pay for procedures, but not for office visits, at higher levels than those paid by Medicare. Payment reform is essential to guarantee a healthy primary care base to the U.S. health care system.

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    • "To enhance reimbursement in primary care is a similar request with obviously high acceptance. Still, inequalities between PCPs and specialists have been described in different health care systems and were found to be an important factor for career choices26272829. 80 % of the hospital physicians rated interventions increasing reimbursement in primary care to be useful but PCPs did so even in 97 %. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Switzerland is facing a shortage of primary care physicians (PCPs); government organizations therefore suggested a broad variety of interventions to promote primary care. The aim of the study was to prioritize these interventions according to the acceptance and perceived barriers of most relevant groups of physicians in this context (hospital physicians and PCPs). Methods: The study was conducted during summer 2014. An online-based questionnaire assessed demographic data, working conditions and future plans. Participants were asked to rank the usefulness of 22 interventions to promote primary care. Interventions to promote primary care that received ratings of 4 or 5 on the Likert scale (corresponding to "useful" or "very useful") by at least 80 % of the participants were categorized as interventions with very high acceptance. We analyzed whether the groups (PCPs, hospital physicians) ranked the interventions differently using the Mann-Whitney U test. We assumed a two tailed p < 0.05 after Bonferroni correction for multiple testing as statistically significant. Results: Two hundred thirty physicians (response rate 58.4 %) completed the survey. Among those 69 PCPs and 66 hospital physicians were included in the analysis. Among those 14 PCPs were planning to leave clinical practice due to retirement, whereas only 8 hospital physicians planned a career as PCPs. Among PCPs the intervention with the highest acceptance was the increase of reimbursement, whereas family friendly measures achieved highest acceptance among hospital physicians. Financial support for primary care traineeships was considered to be very useful by both groups. Conclusions: Interventions on PCPs close to retirement or on PCPs considering an early retirement will not adequately prevent shortage of primary care providers. Governmental interventions should therefore also aim at encouraging hospital physicians to start a career in primary care by governmental support for traineeships in primary care and investments in family friendly measures.
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    • "They cooperate with this program as part time physicians and seek further education to gain a competitive advantage and better social position and income because there is a huge gap between income and position of general practitioners and specialists in Iran. Studies carried out in the USA [28] and 14 Organization for Economic Cooperation and Development countries [29] showed that there is a large gap between income of specialists and general practitioners working in PHC. This trend increases the worries related to a shortage of general practitioners in these countries. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Rural family physician program as the new reform in the Iranian health system has been implemented since 2005. Its success depends much on physicians’ retention. The present study aimed to identify influential factors on physicians’ willingness to leave out this program in Kerman province. Methods: The present cross-sectional study was performed in Kerman province in 2011. All family physicians working in this program (n = 271) were studied using a questionnaire. Data analysis was carried out using descriptive statistics and logistic regression through SPSS version 18.0. Results: Twenty-six percent (70) of the physicians had left out the program in the past. In addition, 77.3% (208) intended to leave out in the near future. Opportunity for continuing education, inappropriate and long working hours, unsuitable requirements of salary, irregular payments, lack of job security and high working responsibility were regarded as the most important reasons for leaving out the program in the past and intention to leave out in future orderly. According to univariate logistic regression, younger physicians (odds ratio [OR] =2.479; 95% confidence interval [CI]: 1.261-4.872) and physicians who had older children (OR = 4.743; 95% CI: 1.441-15.607) were more willing to leave out the plan in the near future, however it was not significant in multivariate logistic regression. Conclusions: Physician retention in family physician program is faced with serious doubts due to different reasons. The success of the program is endangered because of the pivotal role of human resources. Hence, the revision of human resources policies of the program seems necessary in order to reduce physicians leave out and improving its effectiveness.
    Full-text · Article · Oct 2014 · International journal of preventive medicine
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    • "This effort reflected an attempt to standardize Medicare payments to physicians [2], and many other payers followed Medicare's lead. Despite this attempt at standardization, however, income disparities between specialists and generalists have persisted for a variety of reasons, including increasing volume of procedures and weaknesses and political pressures within the Relative Value Scale update process that continue to favor the status quo [3]. The result is a system no more equitable than those of the past. "
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