http://www.medscape.com/viewarticle/731131?src=mpnews&spon=34&uac=91714FXFrom Medscape Medical NewsSignificant Discrepancies in Physician Hourly Wages Exist Across Specialties
Nancy Fowler Larson
October 25, 2010 ― Physicians' hourly wages vary substantially depending on specialty, ranging from a high of $132 for neurologic surgeons to less than $50 for those in certain areas of primary care, according to a study published October 25 in the Archives of Internal Medicine
Such discrepancies ― which may deter medical students from pursuing primary care and create an increased reliance on more costly specialists ― have been documented in numerous studies. However, much of the previous research is limited by its failure to take into account the number of hours worked, among other flaws.
"Considerable data are available that rank physician specialties by annual income, which is one potential indicator of relative valuation," write J. Paul Leigh, PhD, from the Center for Healthcare Policy and Research, University of California–Davis School of Medicine, and colleagues. "However, some data in these studies were collected from physicians employed in medical schools and from nonrepresentative community practitioner samples, limiting the ability to generalize their findings."
In a cross-sectional analysis, the investigators examined data regarding 6381 physicians in 60 communities who were included in the 2004 to 2005 Community Tracking Study physician survey.
Running Tobit and linear regressions, the researchers scrutinized 4 broad specialty groups: primary care (including pediatrics, geriatrics, family practice, internal medicine, general practice, and internal medicine/pediatrics), surgery (including general, neurologic, plastic, orthopedic, otolaryngologic, thoracic, urologic, and vascular surgery, as well as obstetrics/gynecology), internal medicine and pediatric subspecialties (including allergy and immunology, hematology and oncology, gastrointestinal, cardiovascular, nephrology, pulmonary, critical care, hospitalists, rheumatology, endocrinology, infectious disease, and neonatal and perinatal care), and "other" (radiation oncology, occupational medicine, emergency medicine, adult and child psychiatry, neurology, ophthalmology, and dermatology), along with 41 distinct specialties.Highest-Paid Physicians Make More Than 2.5 Times More Than Lowest Earners
According to Tobit-adjusted results, the mean yearly income for all physicians was $187,857 in 2004 to 2005 dollars, earned while working a mean 53.1 work hours during a mean 47.3 weeks.
With regard to the broad groups, unadjusted figures demonstrated that those in surgery led the earnings per hour ($92.10), followed by other medical specialties ($88.08) and internal medicine and pediatric subspecialties ($84.85) and primary care ($60.46). Hourly pay for surgery and for internal medicine and pediatric subspecialties was significantly higher than for primary care physicians (48% and 36% higher than primary care physicians, respectively).Specific findings of unadjusted hourly wages include the following:
* $100/Hour and More
o Neurologic surgery: $132.33 (P = .01 - .05 compared with general surgery)
o Radiation oncology: $126 (P ≤ .01 compared with primary care, broad category)
o Medical oncology: $114.21
o Plastic surgery: $113.78
o Dermatology: $102.68 (P = .05 - .10 compared with general surgery) * $80 to $93/hour
o Cardiovascular diseases: $93.74
o Gastroenterology: $93.27
o Neurology: $92.52
o Emergency medicine: $87.47
o Obstetrics and gynecology: $83.40 * $66 to $75/hour
o Neonatal and perinatal medicine: $75.86
o Psychiatry: $72.24 (P =.01 - .05 compared with general surgery)
o Pulmonary diseases $71.67 (P = .05 - .10 compared with general surgery)
o Pediatrics $69.24 (P =.01 to .05 compared with general surgery)
o Child and adolescent psychiatry: $67.36 (P =.01 to .05 compared with general surgery) * $58/hour and less (P ≤ .01 compared with primary care, broad category, for all)
o Family practice: $58.25
o Internal medicine: $58.18
o General practice: $57.55
o Other pediatric subspecialties: $51.62
o Internal medicine and pediatrics: $49.90
Neurologic surgeons, the highest-paid physicians, worked only 1 hour more each week (58) than the lowest-paid internists and pediatricians (57).
Adjustment for control variables, including age, race, sex, and region, did not significantly alter the results. Earnings were substantially less in adjustment analysis for the 41 distinct specialties than for the broad general surgery group (wage near median, $85.98): internal medicine and pediatrics combined (－$24.36), internal medicine (－$24.27), family medicine (－$23.70), and other pediatric subspecialties (－$23.44).
In a commentary about the study, Michael E. Chernew, PhD, from the Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, notes that the earnings gaps are greater than expected. He also points out that Medicare fee-for-services payments further increase the wage disparities between primary care physicians and specialists.
"This undoubtedly contributes to the shortage of primary care physicians, which likely has deleterious effects on the system as a whole," Dr. Chernew writes.Gap May Be Even Wider Than Study Shows
The investigators stated several limitations to their research:
* the earnings of radiologists, anesthesiologists, and pathologists were not included in the physician survey, and therefore, wage discrepancies between specialists and primary care physicians are likely greater than indicated;
* information was self-reported and cross-sectional, prohibiting findings with regard to causality;
* 71% of the sample was not accessible for the 3 earlier rounds of data gathering; and
* the survey response rate was only 53%, and participation rates may vary among specialties
The researchers concluded that a decreasing interest in primary care by medical students argues for reform, under which primary care physicians would earn more or work fewer hours.
"By accounting for differences in number of work hours and number of weeks worked per year, these findings provide a more complete picture of disparities in remuneration in various physician specialties than has previously been available," the authors write. "As such, they will help inform the contentious health and payment reform debate and will also offer much needed guidance to medical students, medical school and residency program faculty, practicing physicians, health plan administrators, and health policymakers, among others."
The National Institute for Occupational Safety and Health and the University of California–Davis supported the study. The study authors have disclosed no relevant financial relationships.
Arch Intern Med. 2010;1728-1734, 1742-1744.
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