In the midst of every bout of interest in healthcare, there’s always mention of primary care physicians who serve as ‘gatekeepers’ of healthcare. While it makes sense, there’s one catch–you have to have enough primary care physicians:
But there’s one important ingredient missing from that equation — enough primary care doctors to take care of all these newly insured people. And the big reason behind the lack of primary care docs is the fact they get paid shit — relatively speaking. Unlike the rest of the civilized world, physicians in the US are rarely salaried employees. With rare exceptions – generally public hospitals and university hospitals – they’re independent businesses that get paid based on what kind of work they do. The big bucks go to the procedure based specialties; that’s why surgeons can afford the McMansions. Primary care doctors — family practitioners, pediatricians, internists — who spend a lot of their time ‘just’ talking to patients get paid relatively little in comparison. No big surprise there’d be a shortage. Spend 4 years in school racking up $120,000 to $150,000 in debt (and that’s on top of the debt you left college with), you’re probably not going to want to go into a business that pays between $175,000 and $200,000 when surgeons make $300,000 at the low end to over $500,000 for some specialties. (Oh go ahead and play with the site at the link, you know you want to know what your sykiatrist is making.)
The basic problem is that ‘gatekeeping’ isn’t viewed as a medical procedure, so the renumeration is relatively low:
Under the current system of physician reimbursement, primary care doctors will never be able to make as much money as surgeons or other procedure based specialties. There just aren’t enough ‘procedures’ in their repetoire. They get paid for a basic office visit, or maybe a hospital visit. Period. The surgeon gets paid for the office visit, plus a hospital visit, plus all the various things she does when she gets you in the OR. And there’s really no mystical reason why there’s any more economic value to being able to repair your torn ACL than there is to managing the diabetes that threatens to destroy your kidneys.
And there’s some backwards economics underlying how this works (italics mine):
The easiest way to fix the discrepancies — and thus ease the primary care shortage — would be to allow hospitals to employ the physicians directly, but it’s against the law in most states. If hospitals could hire the docs, over time pay would start to move towards the middle. The orthopedic surgeon isn’t really worth that much more to the hospital than the family practioner. An argument can be made that the FP is actually more valuable since they’re the primary gatekeeper into the whole system. The problem is, most states have what are called ‘corporate practice of medicine’ laws which means only a physician can employ another physician. Restraint of trade at its most basic. And state medical societies lobby like mad to keep things this way.
A friend who was a primary care physician in Rhode Island recently left because the income for PCPs was awful. You would think that PCPs might turn against some of their colleagues–after all, their economic interests are not aligned. Maybe there’s a fracture line here?
If PCPs are this vital, why do we pay them the least?