The work is interesting and definitely secure — by 2020 the U.S. Census Bureau predicts there will be 250,000 centenarians — but geriatrics is far from financially lucrative. “A lot [of physicians] are frustrated because it takes more time and effort, but they don’t get paid as much because many of these patients rely on Medicare.”



Mosley observes that such is often the way with healthcare roles. “A nurse practitioner says, ‘Gosh, I do as much as an internist, I should get paid as much.’ An internist does as much as a specialist, so he thinks he should also make more.”

Specialists do go through more training. Is it really fair to begrudge them a monetary gain from that? No, says Rosenstock, and she doesn’t. “I don’t have a problem with what specialists make. They go through a very tough fellowship. What’s more frustrating to me is the amount of uncompensated time we spend as primary-care physicians. I spent an hour at a nursing home this morning. That’s uncompensated time. A lot of what we do is uncompensated. Phone calls, e-mail — all uncompensated.”



Family practitioners shook up the stats even more for income relative to perceived effort: 59.3 percent now report disenchantment with their pay packages — a full 10 percent increase from the year before.

However, pediatricians veer from the pack on this point. Though they make less than family practitioners and internists, more than half (54.9 percent) consider their paychecks to be acceptable or better. Specifically, 41.5 percent think their pay is “appropriate” and 13.4 percent describe it as “excellent” — an overall satisfaction increase of 6.6 percent over last year. “They go in it for the love of the game,” says Mosley. “A lot, even after they retire, still take on other work like summer camps or giving free physicals. They’re not as money-driven as the IMs or FPs.”

Poised for change

The percentage of physicians identifying themselves as “very satisfied” dipped from 24.3 percent to 18.3 percent, while the percentage saying they are “very dissatisfied” increased to 13.2 percent from 9.4 percent.

Nevertheless, fewer docs this year than last said they would steer clear of medicine if they could turn back time (21.8 percent this year compared to 28.6 percent last year). While it’s true that not all of them would choose primary care again, 39.5 percent would, up slightly from last year. But there are always a certain number of people plagued by the shoulda-coulda-wouldas regardless of occupation. And, of course, no one’s denying there are in fact some good reasons to bow out of primary care.



A new question to this year’s survey reveals trepidation among primary-care physicians. Forty percent said “yes” when asked if they believed primary care will continue to play a vital role in healthcare in the United States. Less than 14 percent believe it will disappear.

Despairing physicians are likely to be buoyed by predictions that the current payer-driven model, with its diminishing physician reimbursements and increasing out-of-pocket costs for patients, will not hold up much longer. Changes are coming, say experts. The standard, patient-volume practice model, driven by today’s multipayer system, will eventually fail, says Brian McCartie, a regional vice president for the national recruiting firm Cejka Search. But not just yet.



“I think it’s going to get worse before it gets better. The boomers are still taking the bulk of the work. They’re still the basis of our primary care today. But what happens when they start retiring? They’re not being replaced by the same.” By this McCartie means that the old guard is set in its ways, and until more retire the current system will likely remain in place. But it’s just a matter of time. Notably, the new docs coming out of medical school have a different perspective on their careers. Unlike their predecessors, they place much more emphasis on the concept of “work-life balance.”