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UCD study finds medical wage discrepancies

By November 3, 2010

Special to the Enterprise

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SACRAMENTO — A national study of physician wages conducted by UC Davis Health System has found that specialists are paid as much as 52 percent more than primary-care doctors, even though primary-care doctors see far more patients.

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As efforts to implement health care reform evolve, the study is important because it quantifies wage disparities and explores the need for wage reform to help assure a strong primary-care workforce.

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“Addressing the generalist-specialist income gap is critical to increasing access to cost-effective preventive care,” said J. Paul Leigh, a professor in the UCD Center for Healthcare Policy and Research and lead author of the study, published in the Oct. 25 issue of the Archives of Internal Medicine.

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“There is a huge shortage of primary-care physicians, and in years to come many more of them will be needed to meet health care reform goals.”

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The wage differences add up to millions of dollars over a lifetime, according to senior author Richard Kravitz, a professor of internal medicine and investigator with the Center for Healthcare Policy and Research. The result, he said, is a critical shortfall in the number of U.S. medical students entering generalist careers, in part because of the realization that peers in specialties such as radiology and dermatology will be making more money for less work.

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“There is this sense that society simply doesnt value primary care,” he said.

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For the nationwide study, the investigators compared wages of more than 6,000 doctors practicing in 41 specialties in 60 communities. The data came from the 2004 to 2005 Community Tracking Study, a periodic evaluation of physician demographic, geographic and market trends.

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Unlike previous studies analyzing income disparities, the research team compared hourly wages, factoring in the hours per day physicians reported working and excluding vacation time. The 2005 hourly wages for four broad specialty categories were as follows:

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* Primary care, including pediatrics, geriatrics, family practice and internal medicine: $60.48 per hour.

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* Internal medicine and pediatric subspecialties, including allergy and immunology, gastrointestinal, cardiovascular, rheumatology, pulmonary, critical care, medical oncology and neonatal: $84.85 per hour.

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* Other medical specialties, including radiation oncology, physical medicine and rehabilitation, emergency medicine, psychiatry, neurology, ophthalmology and dermatology: $88.08 per hour.

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* Surgery, including neurological, plastic, ortho-paedic and obstetrics/gynecologic: $92.10 per hour.

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The specialists with the highest wages were neurological surgeons, radiation and medical oncologists, dermatologists, orthopaedic surgeons and ophthalmologists. In general, physicians who earned the most money either performed surgery, deployed sophisticated technologies or administered expensive drugs in office settings.

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Lower-paid specialties primarily relied on talking with and examining patients.

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An over-reliance on highly specialized medicine results in skyrocketing costs as well as poorer overall health, as prevention and primary medical care are de-emphasized, according to Kravitz.

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The solution, he said, lies in reducing the wage disparities and redesigning the payment structure for care.

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— UC Davis Health System

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Karen Finney

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