Journal of General Internal Medicine

, Volume 23, Issue 9, pp 1477–1481 | Cite as

Sources of U.S. Physician Income: The Contribution of Government Payments to the Specialist–Generalist Income Gap

  • Karen E. Lasser
  • Steffie Woolhandler
  • David U. Himmelstein



Physician income varies threefold among specialties. Lower incomes have produced shortages in primary care fields.


To investigate the impact of government policy on generating income differentials among specialties.

Design and Participants

Cross-sectional analysis of the 2004 MEPS.


For outpatient care, total payments made to 27 different types of specialists from five types of payers: Medicare, Medicaid, other government (the Veterans Administration and other state and local programs), private insurance, and out-of-pocket payments. For inpatient care, aggregate (i.e., all-specialty) inpatient physician reimbursement from the five payers.


In 2004, physicians derived 78.6% of their practice income ($149,684 million, 95% CI, $140,784 million—$158,584 million) from outpatient sources and 21.4% of their income ($40,782 million, 95% CI, $36,839 million—$44,724 million) from inpatient sources. Government payers accounted for 32.7% of total physician income. Four specialties derived > 50% of their outpatient income from public sources, including both the lowest and highest paid specialties (geriatrics and hematology/oncology, respectively).


Inter-specialty income differences result, in part, from government decisions.

Key words

physician income contribution of government payments specialist–generalist income gap 



Maxim D. Shrayer Ph.D. provided constructive comments on earlier drafts of this paper; Melbeth G. Marlang, BA, assisted in manuscript preparation.

Conflict of Interest

None disclosed.

Supplementary material

11606_2008_660_MOESM1_ESM.doc (160 kb)
ESM 1 (DOC 159 kb)


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Karen E. Lasser
    • 1
  • Steffie Woolhandler
    • 1
  • David U. Himmelstein
    • 1
  1. 1.Department of MedicineThe Cambridge Health Alliance and Harvard Medical SchoolCambridgeUSA

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