John Meigs Jr., a family-medicine physician in Centreville, Ala., and president of the American Academy of Family Physicians, leaves no doubt on the topic of whether primary-care physicians are underpaid compared to other medical specialties. "Certainly, there's research out there, there's data that shows that family physicians provide the most complex care of any medical specialty. We bring value to the system," he says. "The problem in our current fee-for-service system … [is] it rewards volume more than value."
A Shortage of Primary-Care Doctors
At the same time a debate is forming over their pay, primary-care physicians are seeing a dearth of new recruits coming into the field, according to a recent analysis from the American Academy of Medical Colleges (AAMC). AAMC says there will be a shortage of up to 31,100 primary-care physicians by 2025.
However, Matthew Schick, senior legislative analyst at AAMC, says money isn't the main issue. He says AAMC's analysis has found, when picking a specialty, medical school graduates aren't looking at income potential and debt so much as whether the specialty fits their personality, offers interesting content, and provides a work-life balance. According to AAMC's own data, he says less than half of recent medical school graduates say they looked at income potential and medical school debt when picking a specialty.
Mosley's data similarly found potential income ranked b elow other factors when choosing a specialty. For Meigs and Creevy, neither said they went into their specialty with finances in mind. It was the job's day-to-day activities that drew them to their fields.
Yet experts recognize that money plays some factor into physicians' career decisions. After all, according to the New England Journal of Medicine, the difference in income over a 35-year to40-year career between subspecialists and primary-care physicians is $3.5 million. "I think people do [look at potential income], probably students, particularly if they are incurring substantial debt. Your ability to pay off debt is going to be different if you are an orthopaedic surgeon with a proposed income in the low [$400,000 range] compared to primary care, where it's less than half of that," Creevy says.
In that regard, Meigs says in order to increase the number of medical students going into primary care, they have to be exposed in medical school to the breadth, complexity, and engagement that family medicine physicians have with their patients. They also have to be paid appropriately. "It's got to start with the right people getting into medical school, the right exposure in medical school, and appropriate payment for the value we bring into the system," he says.
The Potential of Value-based Care
If it seems the word value keeps coming up in connection with primary-care physician compensation, there is a reason why. Experts conclude that through the shift to value-based care payment models, primary-care physicians are going to see a bigger piece of the revenue pie. Specifically, Medicare reimbursement under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will lead the charge, they predict.
"MACRA begins Medicare's transition from volume-based payment to value-based payments. MACRA is a complex law; it's not perfect. But it does begin the shift toward recognizing team-based care and payment for non-face-to-face services, [care] coordination, and efficient, high-quality healthcare," says Meigs, who adds that when medical students see the prominence of primary-care physicians in this value-based environment — including an increased income — they'll be more likely to choose that career path.