Medicare Policies Fuel Specialist-Generalist Physician Income Gap

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NEWS FROM CAMBRIDGE HEALTH ALLIANCE

July 7, 2008

Medicare Policies Fuel Specialist-Generalist Physician Income Gap

New Study from Harvard Medical School Researchers at Cambridge Health Alliance Finds Government Decisions Contribute to Primary Care Shortage

Cambridge, MA……Payments from government health insurers overpay specialists relative to primary care doctors and exacerbate the shortage of primary care physicians, according to a study by Harvard Medical School researchers at Cambridge Health Alliance. The study, released online by the Journal of General Internal Medicine, will be published in the September 2008 issue.

The authors found that among the four medical specialties (geriatrics, hematology-oncology, nephrology and rheumatology) deriving more than half of revenues from government sources, incomes vary more than threefold. For instance, geriatricians' incomes averaged $165,000 annually vs. $504,000 for hematologists; the two specialties require a similar amount of training. Cardiologists and urologists - two other highly paid specialties - also derive more than one-third of their incomes from Medicare. In total, Medicare accounts for 21.1% of payments to doctors, Medicaid for 6.8% and other government programs for 3.2%.

The study analyzes the Medical Expenditure Panel Survey, a national health survey carried out by US official statistics agencies. The data underestimate the extent to which government sources contribute to physician revenue, as nursing home residents (most of whom have Medicare and/or Medicaid), active duty military personnel, and prisoners are not surveyed.

Lead author Dr. Karen Lasser, a primary care physician at Cambridge Health Alliance and an assistant professor of medicine at Harvard Medical School, commented, "It's no surprise that there is a shortage of primary care doctors when debt-burdened medical students have much more lucrative career options. What is surprising is that government fee schedules are behind much of this income discrepancy."

Study co-author Dr. Steffie Woolhandler, a primary care physician at Cambridge Health Alliance and an associate professor of medicine at Harvard Medical School, added, "The average cardiologist makes about as much from Medicare - which accounts for less than half of his or her practice - as the entire income of a geriatrician, who spends full time caring for elderly Medicare patients. Politicians like to bemoan the shortage of primary care doctors, but their policies are creating that shortage."

Dr. Karen Lasser has worked as a primary care physician in community health centers since 1995. In addition to her current roles at Cambridge Health Alliance (CHA) and Harvard Medical School, she serves as the Director of Ambulatory Quality Improvement for the Department of Medicine at CHA. She earned her medical degree from Cornell University Medical College with honors in research and holds a master's degree in public health from Harvard University. With an overarching interest in quality of care in primary care for underserved populations, she has published in the areas of cancer prevention, tobacco control, quality of medication prescribing, and access to care.

The study, titled "Sources of U.S. Physician Income: The Contribution of Government Payments to the Specialist-Generalist Income Gap," was published online by the Journal of General Internal Medicine and will appear in the September 2008 issue. Authors Karen E. Lasser, MD, MPH, Steffie Woolhandler, MD, MPH, and David U. Himmelstein, MD, are physicians at Cambridge Health Alliance and hold faculty appointments at Harvard Medical School.

Cambridge Health Alliance is an innovative, award-winning health system that provides high quality care in Cambridge, Somerville, and Boston's metro-north communities. It includes three hospital campuses, more than 20 primary care and specialty practices, the Cambridge Public Health Dept., and the Network Health plan. CHA is a Harvard Medical School teaching affiliate and is also affiliated with Harvard School of Public Health, Harvard School of Dental Medicine, and Tufts University School of Medicine.