 |
 |
|
|
|  PubMed
|
| ||||||||||||||||||||||||||||||||||||||||||||
20 February 2007 | Volume 146 Issue 4 | Pages 301-306
A large, widening gap exists between the incomes of primary care physicians and those of many specialists. This disparity is important because noncompetitive primary care incomes discourage medical school graduates from choosing primary care careers.
The Resource-Based Relative Value Scale, designed to reduce the inequality between fees for office visits and payment for procedures, failed to prevent the widening primary care–specialty income gap for 4 reasons: 1) The volume of diagnostic and imaging procedures has increased far more rapidly than the volume of office visits, which benefits specialists who perform those procedures; 2) the process of updating fees every 5 years is heavily influenced by the Relative Value Scale Update Committee, which is composed mainly of specialists; 3) Medicare's formula for controlling physician payments penalizes primary care physicians; and 4) private insurers tend to pay for procedures, but not for office visits, at higher levels than those paid by Medicare. Payment reform is essential to guarantee a healthy primary care base to the U.S. health care system.
Author and Article Information
From University of California, San Francisco, San Francisco, California, and the Urban Institute and Arent Fox, PLLC, Washington, DC.
Potential Financial Conflicts of Interest: Consultancies: P. Rudolf (American College of Physicians, American Geriatrics Society).
Requests for Single Reprints: Thomas Bodenheimer, MD, Building 80-83, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110; e-mail, TBodenheimer{at}fcm.ucsf.edu.
Current Author Addresses: Dr. Bodenheimer: Building 80-83, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110.
Dr. Berenson: Urban Institute, 2100 M Street NW, Washington, DC 20037.
Dr. Rudolf: Arent Fox, PLLC, 1050 Connecticut Avenue NW, Washington, DC 20036. PERSPECTIVE
The Primary Care–Specialty Income Gap: Why It Matters
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  T. Bodenheimer, K. Grumbach, and R. A. Berenson A Lifeline for Primary Care N. Engl. J. Med., June 25, 2009; 360(26): 2693 - 2696. [Full Text] [PDF]
|
|
|
|
 |
|
 R. McDonald and M. Roland Pay for Performance in Primary Care in England and California: Comparison of Unintended Consequences Ann. Fam. Med, March 1, 2009; 7(2): 121 - 127. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Berlin The Four S's: A Response to Market Forces Influencing Imaging Am. J. Roentgenol., March 1, 2009; 192(3): 565 - 567. [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Cunningham and A. S. O'Malley Do Reimbursement Delays Discourage Medicaid Participation By Physicians? Health Aff., January 1, 2009; 28(1): w17 - w28. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. S. Ross and A. S. Detsky Comparison of the US and Canadian Health Care Systems: A Tale of 2 Mount Sinai's JAMA, October 22, 2008; 300(16): 1934 - 1936. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Grover When Money Doesn't Change Everything Ann Intern Med, September 16, 2008; 149(6): 429 - 430. [Full Text] [PDF]
|
|
|
|
 |
|
 T. C. Rosenthal The Medical Home: Growing Evidence to Support a New Approach to Primary Care J Am Board Fam Med, September 1, 2008; 21(5): 427 - 440. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Berenson, T. Hammons, D. N. Gans, S. Zuckerman, K. Merrell, W. S. Underwood, and A. F. Williams A House Is Not A Home: Keeping Patients At The Center Of Practice Redesign Health Aff., September 1, 2008; 27(5): 1219 - 1230. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. K. Iglehart Medicare, Graduate Medical Education, and New Policy Directions N. Engl. J. Med., August 7, 2008; 359(6): 643 - 650. [Full Text] [PDF]
|
|
|
|
|
|
S. E. Harrington and T. J. Smith The Role of Chemotherapy at the End of Life: "When Is Enough, Enough?" JAMA, June 11, 2008; 299(22): 2667 - 2678. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Colwill, J. M. Cultice, and R. L. Kruse Will Generalist Physician Supply Meet Demands Of An Increasing And Aging Population? Health Aff., May 1, 2008; 27(3): w232 - w241. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Baron and C. K. Cassel 21st-Century Primary Care: New Physician Roles Need New Payment Models JAMA, April 2, 2008; 299(13): 1595 - 1597. [Full Text] [PDF]
|
|
|
|
|
|
A. C. Browning The Future of General Surgery JAMA, March 5, 2008; 299(9): 1014 - 1015. [Full Text] [PDF]
|
|
|
|
|
|
J. E. Fischer The Future of General Surgery--Reply JAMA, March 5, 2008; 299(9): 1015 - 1016. [Full Text] [PDF]
|
|
|
|
|
|
M.-J. Sepulveda, T. Bodenheimer, and P. Grundy Primary Care: Can It Solve Employers' Health Care Dilemma? Health Aff., January 1, 2008; 27(1): 151 - 158. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Wigton and P. Alguire The Declining Number and Variety of Procedures Done by General Internists Ann Intern Med, December 4, 2007; 147(11): 815 - 816. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Mueller B-Type Natriuretic Peptides and the General Practitioner J. Am. Coll. Cardiol., October 23, 2007; 50(17): 1702 - 1703. [Full Text] [PDF]
|
|
|
|
|
|
W. L. Rich III The Primary Care-Specialty Income Gap Ann Intern Med, June 19, 2007; 146(12): 895 - 896. [Full Text] [PDF]
|
|
|
|
|
|
P. B. Ginsburg and R. A. Berenson Revising Medicare's Physician Fee Schedule -- Much Activity, Little Change N. Engl. J. Med., March 22, 2007; 356(12): 1201 - 1203. [Full Text] [PDF]
|
|
Read all Rapid Responses
