In the War of Wages, Surgeons Have the Edge

New data looking at hourly wages indicates that surgeons earn significantly more than PCPs, leaving some to question the sustainability of primary care.

Despite the fact that generalists see more patients, specialists earn as much as 52% more money than primary care and generalist physicians, which adds up to millions of dollars over the course of a career, according to research published in the Archives of Internal Medicine.

In the study, researchers from the University of California Davis School of Medicine, Davis, analyzed compensation data from 6,381 physicians in 60 communities from the 2004-2005 Community Tracking Study to compare wages across broad and narrow categories of physician specialties. While previous studies have compared annual incomes across specialties without adjusting for work hours, this study looked at hourly wages based on compensation and reported hours worked per day “to better inform the physician payment debate.”

Using a cross-sectional analysis, J. Paul Leigh, PhD, and colleagues compared wages across four broad specialties—primary care, surgery, internal medicine, and pediatric subspecialties—and 41 narrow specialties, accounting also for demographic, geographic, and market variables.

The investigators found that wages for surgery, internal medicine and pediatric subspecialties, and other specialties were 48%, 36%, and 45% higher, respectively, than for primary care specialties. According to their results, generalists, including pediatricians, earned $60.48 per hour; internal medicine and pediatric specialists earned $84.85 per hour; other specialties, including emergency medicine and dermatology, earned $88.08 per hour; and surgeons earned $92.10 per hour.

“In light of low and declining medical student interest in primary care, these findings suggest the need for payment reform aimed at increasing incomes or reducing work hours for primary care physicians,” the authors wrote.

In another study, Martin Palmeri, MD, of Dartmouth Medical School in Hanover, NH, and colleagues looked at the economic burdens of loan payments on physicians. The average primary care physician, they found, experiences financial difficulties for 3-5 years after residency, with expenses exceeding income and forcing the physician to delay savings and cut expenses.

For their research, which is published in Academic Medicine, investigators compiled data on physician income from various published reports, including surveys from the Medical Group Management Association, the Association of American Medical Colleges and the Bureau of Labor Statistics.

Palmeri and colleagues found that 87% of medical students had a debt that averaged $145,000 for those attending public medical schools, and $180,000 for those attending private schools in 2007. Data showed that the percentage of medical students with debt doubled from 2004 to 2008.

According to the study, if a graduate defers the payment for the loan for three years of residency training, the total debt is $199,159. Distributed over 10 years, the debt translates into a monthly payment of $2,261.

To read the study—entitled, Economic Impact of a Primary Care Career: A Harsh Reality for Medical Students and the Nation—in its entirety, click here.

To access the Archives of Internal Medicine study—entitled Physician Wages Across Specialties: Informing the Physician Reimbursement Debate—click here.

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