Primary-care pay gap overwhelms policy changes to make the field more attractive

Over the course of a 43-year career, primary-care physicians earn less than half as much as their counterparts in cardiology, while physicians in 13 other specialties dwarf their incomes even more, according to a new study published in Health Affairs.

Taking into account medical school debt, earning potential and the age at which doctors begin earning an income, researchers at Duke University calculated that cardiologists earn a career average of more than $5 million, compared with $2.5 million for PCPs, $1.7 million for business school graduates, $846,735 for physician assistants and $340,629 for college graduates, according to the paper.

With the escalating problem of primary-care shortages in mind, the team also determined that primary-care doctors would have to receive a $1 million lump-sum payment, or have an annual income boost of $100,000, to make up the difference over the course of a career, according to the analysis.

"Small incentives are not going to be enough to shift the market in a dynamic way," says Kevin Schulman, a professor of medicine and business administration at Duke University, and one of the study's authors. "The magnitude of the differential on the income side is greater than anything we've been talking about on the policy level."

Potential solutions include cutting reimbursement to specialists, or raising primary-care doctors' salaries to some percentage of what's earned by specialists, which Schulman notes are both fraught with difficulty. Alternatively, the primary-care system could be made more efficient by employing more nurse practitioners or physician assistants, he says.

To learn more:
- read this article in The Medical News
- check out this Wall Street Journal Health Blog post
- read the Health Affairs abstract
- read this Kaiser Health News piece

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