Some physicians will make over 7 times what the average college dropout will earn over a lifetime. Even within medicine there are significant differences in lifetime earnings between primary care, surgery, and specialty care.
With the recent Powerball lottery jackpot at a record high, there was a lot of daydreaming going on recently. One age-old question always comes up amidst that daydreaming: What would you do if you actually won it all? Would you keep working at your same job?
A recent study in this month’s Medical Care raises similar questions for physicians. It reveals how much physicians in various specialties make over their lifetimes and puts this in the context of physicians’ motivation to enter certain specialties, access to care for patients, and policies that attempt to manipulate these forces. This study begs the question, if your neurosurgeon won the Powerball, would he or she show up to work the next day?
The study by Leigh and others collected annual income and work hours data from 6,381 physicians through the 2004-2005 Community Tracking Study; authors drew estimates of the duration of residency training from the American Medical Association’s FREIDA database. They calculated income over a lifetime for various specialties, taking into consideration years of residency and typical age of retirement in each specialty. Per the authors, this study is unique in that it sampled a representative group of physicians and because it took a life-long approach instead of comparing only annual or hourly income.
The results of lifetime income per specialty are shocking as they relate to the income of someone in primary care. For example, the lifetime earnings for physicians in different types of surgery, internal medicine and pediatric subspecialties, and other specialties were $1,587,722, $1,099,658, and $761,402 more than for those physicians in primary care. When comparing specific types of surgeon (e.g. a neurosurgeon) to a specific type of primary care physician (e.g. family practice), there was almost a $3 million difference in earnings over a lifetime. Of the 41 physician specialties included in the study, twelve made the same while 28 earned significantly more lifetime earnings than a family practice physician. Many of the 10 highest lifetime earning specialties either perform surgical procedures or use expensive technologies or medicines (e.g. cardiology and oncology).
Why do such large differences in lifetime earnings between specialists and primary care physicians exist? This study shows that the number of hours worked each year plays only a small role. The authors suspect that part of the difference can be explained because specialties could be viewed as more taxing, with more shift work, on-call hours, and more frequent stressful decision making thus warranting higher compensation. Another factor may be each specialty’s tactic in incorporating non-physician providers into their practice. Specialties tend to have better protection of their value apart from non-physician providers through “scope of practice” legislation and through continued development of new technology and mastery of procedures relegated only to physicians.
Studies have shown that higher earning specialties attract more physicians. To this end, more physicians in the United States are going to enter specialty care rather than primary care. This has important implications for access to care especially with current policies encouraging the use of medical homes.
The Affordable Care Act attempts to make primary care more financially attractive through debt forgiveness and increased Medicaid reimbursement, but is likely inadequate in that it does not come near the $1 to $2 million difference in lifetime earnings between a primary care physician and the average specialist.
It is not a new notion that higher earning specialties draw more physicians and that this phenomenon is drawing physicians away from primary care. Despite longer residency times and earlier retirement, specialists make an outstanding amount of money over a lifetime compared to primary care physicians regardless of hours worked.
Not the main purpose of the authors, but perhaps an equally important point is that, man oh man, physicians – all physicians – in the United States make a ton of money. Although neurosurgeons, with lifetime earnings up to $7 million, do make a significant amount more than family practice physicians, the lower end of the lifetime earnings range for family practice physicians bottoms out at a cool $2.8 million. Doctors, even the least well paid, are not broke.
In many other countries where primary care is robust and health care less expensive, physicians make an honest upper middle-class income. Instead of policies to increase reimbursement for primary care, should we decrease the reimbursement for all other physicians? I would wager that even neurosurgeons in this alternate universe would still work after winning the Powerball.
Lisa Maurer, MD