Sources of U.S. Physician Income: The Contribution of Government Payments to the Specialist–Generalist Income Gap
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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 wordsphysician income contribution of government payments specialist–generalist income gap
- 4.Jarman B, Gault S, Alves B, et al. Explaining differences in English hospital death rates using routinely collected data. Br Med J (Clinical Research Ed.). 1999;318(7197):1515–20.Google Scholar
- 9.Baicker K, Chandra A. Medicare spending, the physician workforce, and beneficiaries’ quality of care. Health Affairs. 2004;Suppl Web Exclusives:W184–97.Google Scholar
- 11.Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Mem Fund Q. 2005;83(3):457–502.Google Scholar
- 15.Berenson A. Sending back the doctor’s bill. The New York Times 2007 July 29;3.Google Scholar
- 16.American College of Physicians. The impending collapse of primary care medicine and its implications in the state of the nation’s health care. A public policy report of the American College of Physicians, Philadelphia: January 30, 2006. Available at http://www.acponline.org/advocacy/events/state_of_healthcare/statehc06_1.pdf Accessed March 31, 2008.
- 21.Medical Group Management Association, Englewood, Colorado, December 2005.Google Scholar
- 23.OECD Health Data 2004: A Comparative Analysis of 30 Countries. Paris: Organisation for Economic Cooperation and Development; 2004.Google Scholar
- 24.Guyatt G, Devereaux PJ, Lexchin J, et al.. A systematic review of studies comparing health outcomes in Canada and the United States. Open Medicine. 2007;1(1):27–36.Google Scholar
- 25.Wassenaar JD, Thran SL, eds. Physician Socioeconomic Statistics. 2000–2002 ed. Chicago, Illinois: American Medical Association; 2001.Google Scholar
- 27.American Geriatrics Society and Association of Directors of Geriatric Academic Programs (ADGAP). Geriatric Medicine: A Clinical Imperative for an Aging Population. New York; 2007.Google Scholar
- 28.Berkman LF, Kawachi I, eds. Social Epidemiology Oxford: Oxford University Press; 2000.Google Scholar