The Primary Care–Specialty Income Gap

TO THE EDITOR:

I read with interest Bodenheimer and colleagues' recent article (1). I am compelled to correct a number of statements within the article and to set the record straight regarding the American Medical Association (AMA) Specialty Society Relative Value Scale Update Committee (RUC) and its role in updating the Resource-Based Relative Value Scale (RBRVS). I hope to provide a balanced perspective of this important committee and its efforts to represent all physicians.

The Medicare RBRVS is designed to pay physician services relative to the resources (physician work, practice expense, and professional liability insurance) required to provide the service. The authors state that the RBRVS was designed to “lessen the fee disparity between office visits … and procedures provided by specialists” (1). Although this was not specifically stated by policymakers, conventional wisdom was that the RBRVS would redistribute payments to evaluation and management (E&M) services. In fact, the RBRVS has continued to redistribute to E&M services, as shown by the service changes in the Table.

Bodenheimer and colleagues assert that gastroenterologists are paid more than primary care physicians for similar work effort. In …