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1.
Bodenheimer  TBerenson  RARudolf  P The primary care-specialty income gap: why it matters.  Ann Intern Med 2007;146 (4) 301- 306PubMedGoogle ScholarCrossref
2.
Lasser  KEWoolhandler  SHimmelstein  DU Sources of U.S. physician income: the contribution of government payments to the specialist-generalist income gap.  J Gen Intern Med 2008;23 (9) 1477- 1481PubMedGoogle ScholarCrossref
3.
Baicker  KChandra  A Medicare spending, the physician workforce, and beneficiaries' quality of care.  Health Aff (Millwood) 2004; ((suppl Web Exclusives)) W184-97PubMedGoogle Scholar
4.
De Maeseneer  JMDe Prins  LGosset  CHeyerick  J Provider continuity in family medicine: does it make a difference for total health care costs?  Ann Fam Med 2003;1 (3) 144- 148PubMedGoogle ScholarCrossref
5.
Goldman  DPSood  N Rising medicare costs: are we in crisis?  Health Aff (Millwood) 2006;25 (5) w389- w392PubMedGoogle ScholarCrossref
6.
Starfield  BShi  LMacinko  J Contribution of primary care to health systems and health.  Milbank Q 2005;83 (3) 457- 502PubMedGoogle ScholarCrossref
7.
Colwill  JMCultice  JMKruse  RL Will generalist physician supply meet demands of an increasing and aging population?  Health Aff (Millwood) 2008;27 (3) w232- w241PubMedGoogle ScholarCrossref
8.
Ebell  MH Future salary and US residency fill rate revisited.  JAMA 2008;300 (10) 1131- 1132PubMedGoogle ScholarCrossref
9.
Kiker  BFZeh  M Relative income expectations, expected malpractice premium costs, and other determinants of physician specialty choice.  J Health Soc Behav 1998;39 (2) 152- 167PubMedGoogle ScholarCrossref
10.
Newton  DAGrayson  MSThompson  LF The variable influence of lifestyle and income on medical students' career specialty choices: data from two U.S. medical schools, 1998-2004.  Acad Med 2005;80 (9) 809- 814PubMedGoogle ScholarCrossref
11.
Thornton  J Physician choice of medical specialty: do economic incentives matter?  Appl Econ 2000;32 (11) 1419- 1428Google ScholarCrossref
12.
Weeks  WBWallace  AE Long-term financial implications of specialty training for physicians.  Am J Med 2002;113 (5) 393- 399PubMedGoogle ScholarCrossref
13.
 HR 3962, 111th Cong, 1st Sess (2009) 
14.
Arvantes  J Expert panel calls for Medicare payment reform.  AAFP News Now. November5 2008;Google Scholar
15.
Nonnemaker  LThomas  SDubow  J Physician Payment: Current System and Opportunities for Reform.  Washington, DC AARP Public Policy Institute2009;
16.
Desmarais  W Report on Medical School Faculty Salaries 2006-2007.  Washington, DC Association of American Medical Colleges2008;
17.
Studer-Ellis  EGold  JSJones  RF Trends in US medical school faculty salaries, 1988-1989 to 1998-1999.  JAMA 2000;284 (9) 1130- 1135PubMedGoogle ScholarCrossref
18.
Terry  K Exclusive survey: earnings: good news for primary care income.  Med Econ 2008;85 (15) 30- 33PubMedGoogle Scholar
19.
Dorsey  ERJarjoura  DRutecki  GW Influence of controllable lifestyle on recent trends in specialty choice by US medical students.  JAMA 2003;290 (9) 1173- 1178PubMedGoogle ScholarCrossref
20.
Shih  YCKonrad  TR Factors associated with the income distribution of full-time physicians: a quantile regression approach.  Health Serv Res 2007;42 (5) 1895- 1925PubMedGoogle ScholarCrossref
21.
Smart  DRSellers  JDivision of Survey and Data Resources, Physician Characteristics and Distribution in the US, 2008 edition.  Chicago, IL American Medical Association2008;
22.
 2009 Physician Compensation Survey, by the American Medical Group Association (AMGA). http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm. Accessed June 10, 2009
23.
Bureau of Labor Statistics, Occupational outlook handbook, 2010-11 edition: physicians and surgeons. http://www.bls.gov/oco/ocos074.htm. Accessed June 10, 2009
24.
Leigh  JPKravitz  RLSchembri  MSamuels  SJMobley  S Physician career satisfaction across specialties.  Arch Intern Med 2002;162 (14) 1577- 1584PubMedGoogle ScholarCrossref
25.
Katz  A Better outcome means more job satisfaction: pilot project in Winnipeg and Halifax to enhance physician-patient communication.  Can Fam Physician 1999;45218- 220Google Scholar
26.
Kravitz  RLShapiro  MFLinn  LSFroelicher  ESS Risk factors associated with participation in the Ontario, Canada doctors' strike.  Am J Public Health 1989;79 (9) 1227- 1233PubMedGoogle ScholarCrossref
27.
Faragher  EBCass  MCooper  CL The relationship between job satisfaction and health: a meta-analysis.  Occup Environ Med 2005;62 (2) 105- 112PubMedGoogle ScholarCrossref
28.
Landon  BEReschovsky  JDPham  HHBlumenthal  D Leaving medicine: the consequences of physician dissatisfaction.  Med Care 2006;44 (3) 234- 242PubMedGoogle ScholarCrossref
29.
Williams  SPotter  FDiaz-Tena  NStrouse  R Statistical Design and Tracing for the Community Tracking Study Physician Survey.  Washington, DC Center for Studying Health System Change2006;
30.
St Peter  RFReed  MCKemper  PBlumenthal  D Changes in the scope of care provided by primary care physicians.  N Engl J Med 1999;341 (26) 1980- 1985PubMedGoogle ScholarCrossref
31.
StataCorp LP, Stata Statistical Software: Release 11.  College Station, TX StataCorp LP2009;
32.
Cameron  ACTrivedi  PK Microeconometrics: Methods and Applications.  New York, NY Cambridge University Press2005;
33.
Baicker  KChandra  A Cooper's analysis is incorrect.  Health Aff (Millwood) 2009;28 (1) w116- w118PubMedGoogle ScholarCrossref
34.
Cooper  RA States with more physicians have better-quality health care.  Health Aff (Millwood) 2009;28 (1) w91- w102PubMedGoogle ScholarCrossref
35.
Weiss  KB Managing complexity in chronic care: an overview of the VA state-of-the-art (SOTA) conference.  J Gen Intern Med 2007;22 ((suppl 3)) 374- 378PubMedGoogle ScholarCrossref
36.
Folland  SGoodman  ACStano  M The Economics of Health and Health Care.  New York, NY Pearson Prentice Hall2004;
37.
Sasser  AC Gender differences in physician pay: tradeoffs between career and family.  J Hum Resources 2005;40 (2) 477- 504Google Scholar
38.
Kaufman  BEHotchkiss  J The Economics of Labor Markets.  New York, NY Thompson-Southwest2005;
39.
Rosenblatt  RAHart  LGBaldwin  LMChan  LSchneeweiss  R The generalist role of specialty physicians: is there a hidden system of primary care?  JAMA 1998;279 (17) 1364- 1370PubMedGoogle ScholarCrossref
40.
Fink  KSBaldwin  LMLawson  HWChan  LRosenblatt  RAHart  LG The role of gynecologists in providing primary care to elderly women.  J Fam Pract 2001;50 (2) 153- 158PubMedGoogle Scholar
Original Investigation
Health Care Reform
October 25, 2010

Physician Wages Across Specialties: Informing the Physician Reimbursement Debate

Author Affiliations

Author Affiliations: Center for Healthcare Policy and Research (Drs Leigh, Tancredi, Jerant, and Kravitz), Department of Public Health Sciences (Dr Leigh), Department of Pediatrics (Dr Tancredi), Department of Family and Community Medicine (Dr Jerant), and Division of General Medicine, Department of Internal Medicine (Dr Kravitz), University of California Davis School of Medicine, Davis.

Arch Intern Med. 2010;170(19):1728-1734. doi:10.1001/archinternmed.2010.350
Abstract

Background  Disparities in remuneration between primary care and other physician specialties may impede health care reform by undermining the sustainability of a primary care workforce. Previous studies have compared annual incomes across specialties unadjusted for work hours. Wage (earnings-per-hour) comparisons could better inform the physician payment debate.

Methods  In a cross-sectional analysis of data from 6381 physicians providing patient care in the 2004-2005 Community Tracking Study (adjusted response rate, 53%), we compared wages across broad and narrow categories of physician specialties. Tobit and linear regressions were run. Four broad specialty categories (primary care, surgery, internal medicine and pediatric subspecialties, and other) and 41 specific specialties were analyzed together with demographic, geographic, and market variables.

Results  In adjusted analyses on broad categories, wages for surgery, internal medicine and pediatric subspecialties, and other specialties were 48%, 36%, and 45% higher, respectively, than for primary care specialties. In adjusted analyses for 41 specific specialties, wages were significantly lower for the following than for the reference group of general surgery (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). Wage rankings were largely impervious to adjustment for control variables, including age, race, sex, and region.

Conclusions  Wages varied substantially across physician specialties and were lowest for primary care specialties. The primary care wage gap was likely conservative owing to exclusion of radiologists, anesthesiologists, and pathologists. 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.

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