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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

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.