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Open Access 01-09-2008 | Editorial

The Specialist–Generalist Income Gap: Can We Narrow It?

Authors: Thomas Bodenheimer, MD, Mina Matin, MD, Brian Yoshio Laing, MD

Published in: Journal of General Internal Medicine | Issue 9/2008

Excerpt

How do we characterize the current era in US health care? Perhaps “a time of increasing costs and decreasing health insurance”. Equally accurate would be “the age of specialism”. Hospitals have reorganized into specialty service lines;1 profitable specialist-owned surgicenters, endoscopy units, and imaging centers have multiplied;2 market-dominant single-specialty groups can negotiate high fees from commercial insurers.3 The gap between the income of many specialists and that of primary care physicians is wide and growing wider, leading a growing number of US medical school graduates to avoid primary care careers.4 …

Berenson RA, Bodenheimer T, Pham HH. Specialty-service lines: salvos in the new medical arms race. Health Affairs Web Exclusive, July 25, 2006.

Berenson RA, Ginsburg PB, May JH. Hospital-physician relations: cooperation, competition, or separation? Health Affairs Web Exclusive, December 5, 2006.

Liebhaber A, Grossman JM. Physicians moving to mid-sized, single-specialty practices. Tracking Report No. 18. Washington DC: Center for Studying Health System Change, August 2007.

Bodenheimer T, Berenson RA, Rudolf P. The primary care-specialty income gap: why it matters. Ann Intern Med. 2007;146:301–6.PubMed

Lasser KE, Woolhandler S, Himmelstein DU. Sources of U.S. physician income: the contribution of government payments to the specialist–generalist income gap. J Gen Intern Med. 2008, in press. doi 10.1007/s11606-008-0660-7.

Medicare Payment Advisory Commission. Medicare Payment Policy: Report to the Congress. March 2008. http://www.medpac.gov

American Medical Association. Report 14 of the Board of Trustees (A-08). The RUC: Recent Activities to Improve the Valuation of Primary Care Services. http://www.ama-assn.org/ama/pub/category/18586.html (accessed July 4, 2008).

Dummit LA. Updating Medicare’s Physician Fees: The Sustainable Growth Rate Methodology. Issue Brief No. 818. Washington DC: National Health Policy Forum, November 10, 2006. http://www.nhpf.org/pdfs_ib/IB818_SGR_11–10–06.pdf (accessed July 4, 2008).

Splitting Medicare’s Sustainable Growth Rate: A Proposal to Strengthen Medicare and Primary Care. February 14, 2008. http://healthaffairs.org/blog/author/matin (accessed July 4, 2008).

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http://www.medpac.gov/transcripts/04090410medpac.final.pdf

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Medicare Payment Advisory Commission. Report to the Congress. Increasing the Value of Medicare. June 2006. http://www.medpac.gov

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Goroll AH, Berenson RA, Schoenbaum SC, Gardner LB. Fundamental reform of payment for adult primary care: comprehensive payment for comprehensive care. J Gen Intern Med. 2007;22:410–5.PubMedCrossRef

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http://www.pcpcc.net

14.

Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Affairs. 2008;27:759–69.PubMedCrossRef

15.

Testimony Before the Senate Committee on Health, Education, Labor, and Pensions. Primary Care Professionals. US Government Accountability Office, February 12, 2008.

Title: The Specialist–Generalist Income Gap: Can We Narrow It?
Authors: Thomas Bodenheimer, MD
Mina Matin, MD
Brian Yoshio Laing, MD
Publication date: 01-09-2008
Publisher: Springer-Verlag
Published in: Journal of General Internal Medicine / Issue 9/2008
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-008-0740-8

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