| Starting Salaries Linked To Primary Care Physician Shortage
Salary disparities between specialties have been linked
to the shortage of primary care physicians, according to a new study by
researchers at the University of Georgia.
Dr. Mark Ebell, a professor and assistant to the provost
at the University of Georgia, compared 2007 starting salary data for
various physician specialties with the percentage of medical school
graduates choosing those specialties. He found a strong, direct
correlation between salary and the popularity of a specialty.
"Countries with the healthiest primary care systems tend
to have the best health outcomes," Ebell said. "We rank behind many
countries in the quality and efficiency of healthcare, and I think a
lot of that is because we have neglected primary care."
Among his findings:
a. Family medicine had the lowest average salary ($185,740) and the
lowest percentage of filled residency positions among U.S. graduates
(42 percent).
b. Radiologists and orthopedic surgeons, who had an
average salary of more than $400,000, had the highest percentage of
filled residency positions among U.S. graduates (88.7 percent and 93.8
percent, respectively).
The link between average salary and the popularity of a
specialty is not surprising, particularly to Ebell. He conducted a
similar study nearly 20 years ago and found the same relationship.
Since then, however, the salary disparities have grown and the shortage
of primary care physicians — which includes those who specialize
in family medicine, pediatrics or general internal medicine — has
become more pronounced.
In the past decade alone, for example, the number of
U.S. medical school graduates entering family practice residencies has
dropped by 50 percent. Studies have linked a lower percentage of
primary care physicians with higher infant mortality rates, higher
overall death rates and more deaths from heart disease and cancer.
Ebell said he conducted the study to draw renewed
attention to the role of salary disparities in the primary care
shortage and to encourage policymakers to enact meaningful reforms to
increase the percentage of primary care physicians.
"The problem of salary disparities is not something that
anyone is going to solve locally," Ebell said. "This is something that
will require reform at a national level."
He said one possible reform is expanded debt relief for
students who choose primary care practices and in particular those who
choose to practice in underserved areas. He notes that the average debt
for a medical school graduate has quadrupled — from $35,000 to
$140,000—in the nearly 20 years since his original study. When
students graduate with the equivalent of a mortgage in debt, he said,
they can’thelp but be drawn to high-paying specialties rather
than primary care.
Changes to insurance reimbursements, which currently
hurt primary care by rewarding the delivery of diagnostic tests and
medical treatments over time spent communicating with patients, are
also needed to reduce salary disparities, he said, and have the
potential to improve quality of care by reducing unnecessary or
duplicative interventions.
Ebell said the broad knowledge base of primary care can
be intimidating to students, so creating information technology systems
to manage information will be important. Exposing students to primary
care physician role models is another way to sustain interest in
primary care throughout a student’s training.
"A career in primary care can be very rewarding," Ebell
said, "and mentors can show students the satisfaction that comes from
building relationships over time with patients."
The study was published in the Journal of the American Medical Association
Address: University of Georgia, Administration Building, Athens, GA 300602; (706) 542-3000, www.uga.edu.
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