Health Care Gap

Here is an article in the WSJ that is worth mentioning.  I am displaying it all here because many can’t get to the link for free:

One likely factor in America’s outsized health care bill: the huge premium that specialists earn over general practitioners. A new study (in the journal Medical Care)estimated the lifetime earnings gap…and finds it to be gaping. Primary care doctors were projected to make roughly $3 million, for example, but oncologists might earn more than $7 million. Looking at practitioners in broad groups, the researchers found that surgeons out-earned primary care physicians by $1.6 million. Internal medicine and pediatric sub-specialties out-earned by $1.1 million. And other specialists averaged a $761,000 differential. These numbers may help explain why 67 percent of American physicians are specialists. It may also help explain why we spend far more on health care, as a proportion of GDP, than do comparable nations. Primary care physicians provide more cost-effective care, and having more of them could help combat the fragmented nature of care in the U.S. system. The Association of American Medical Colleges predicts a shortage of more than 65,000 primary care doctors by 2025. Researchers suggest medical compensation be restructured to narrow the pay gap and encourage more young doctors to become primary care physicians.

Personally, I do not believe that I, as a family doc, should get the same pay as a specialist.  Well, most specialists.  A neurosurgeon spends more years in residency getting his or her ass kicked to get to that level.  I get that.   We just need to narrow the pay gap.  The country needs more primary care DOCTORS (emphasized on purpose) and that is the biggest way to foster that.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “Health Care Gap

  1. Dr Bonz
    October 10, 2012 at 9:14 pm

    Doug, we’ve had this convo before but just to reiterate, I work SIGNIFICANTLY more hours than any family doc I know. As you stated, my residency was longer and much more grueling. What you have failed to mention is that while there is a gap in salary there is also a gap in what I have to pay in malpractice than my FP colleages. And that gap is MUCH larger percentage wise, than the salary gap you mentioned. My brother is a FP and as my name implies, I am an orthopedic surgeon. My yearly premiums are roughly 12X higher than his and he has a huge practice. Also, my overhead is much higher than almost every FP I know. So while I agree with some of what you say, there are REASONS beyond simple greed (as many of your rants about specialist earning more than FPers seem to imply) for these gaps, only some of which I have mentioned.

    • Doug Farrago
      October 11, 2012 at 7:04 am

      Agree to disagree, then. Let’s take employed specialists vs. employed family docs. Malpractice and overhead is now out of the equation. The gap needs still needs to decrease. It would be the only way to reshuffle the deck for the next generation of docs.

  2. John
    October 10, 2012 at 1:41 pm

    Still do not understand why more primary care docs don’t go the membership or concierge route. You can do it yourself without paying a company to set it up for you and pay a large fee with a long term contract. Don’t know if I’m allowed to put an email address, but I have put together a PDF telling you how and will email to you.
    [email protected]

  3. Kurt
    October 10, 2012 at 1:26 pm

    I and a fair number of FP’s are telling students to stay away.
    I agree we don’t deserve to be paid at a neurosurgeon’s level for
    the facts presented. The fact is that few patients listen to us
    as far as good health practices are concerned. There are no financial consequences for those who eat crap, smoke or abuse “mind altering” substances. If they were listening, we wouldn’t have an obesity epidemic now would we? Yet the ivory tower boys want to penalize hospitals and primary care docs for people who keep having “issues” that we as physicians have no control over. Plus……. I don’t care how well one takes care of themself, we all eventually die. No one lives forever. End of life issues become more difficult for the “healthy livers” who unfortunately are dying more slowly as a result of good health habits.

  4. Ken
    October 7, 2012 at 1:24 pm

    I think “consultants” is a better word than “specialists”. Family docs are specialists in family medicine. Otherwise I agree with everything in Doug’s post. Unfortunately the AAFP is such a flaccid organization that I strongly suspect nothing will change.

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