First-stop docs could get a pay raise

Specialists don’t want to sacrifice pay to primary care docs

Despite bitter disputes over the best ways to overhaul the health care system, there’s consistent agreement about the need to expand the role of primary care doctors. Those physicians are in short supply, and experts are predicting a pay raise for these doctors whose speciality is keeping patients healthy.

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Listen: [audio:090824tedoctors.mp3]

Crimm: Everything looks really good. The diabetes control test is perfect at 6.3, it’s right where we want it to be, and the cholesterol test looks good as well.

Philadelphia physician Allan Crimm is a primary care doctor. That’s a catchall title for the internists, pediatricians and family physicians who are often the first-stop for patients.

Crimm says he and other primary care doctors try to devote extra time to patients. During this appointment with Anna Ciccone, Crimm’s listening for ways to nudge the 75-year-old toward healthier habits.

Ciccone: I just watched what I was eatin.’ And then of course the housework helps, and I’ve been gardening.
Crimm: Good for you, what have you been growing?
Ciccone: Tomatoes, green peppers ..

Crimm says the time he spends on counseling and education pays off in better patient health, but he’s not well paid for that work.

Crimm: An EKG which will take a physician approximately a minute to read and interpret, when a physician performs that in the office, they get paid almost as much for doing that as for actually seeing the patient and spending 15 or 20 minutes with the patient.

Primary care doctors, like Dr. Crimm, say they fall to the bottom of the pay scale because physician fees are heavily weighted toward tests and procedures.

Crimm: That creates perverse incentives to do less of the face-to-face encounters with patients and more and more test ordering.

In a new survey from Modern Healthcare, salaries for primary care physicians range from about $150,000 to the low 200s.

University of Pennsylvania policy expert David Grande …

Grande: Certainly physicians are among the most well paid professionals, so it’s a big mistake to cry poverty if you are practicing physician in the United States. That said, there’s a big, big pay disparity.

Cardiologists, urologists and other specialists commonly earn two or three times more than primary care doctors. Physicians often leave medical school saddled with six-figure debt, and Grande says primary care salaries aren’t high enough to pay off those loans comfortably.

Grande: It’s harder and harder to convince people to go into these careers when in fact they’re desperately needed.

Some primary care doctors are so fed up they’re re-arranging their practices to give themselves a raise. In the practice model sometimes called “concierge” medicine, patients pay 15 to 25-hundred dollars each year to get extra attention from the doctor.

Wayne Lipton leads a company that helps doctors make the switch.

Lipton: The patient experience is something akin to old-fashion approach to medicine, where doctors did not feel compelled to cut you off and give you just a few minutes and only deal with the problem du jour.

Critics think concierge medicine leaves poor people with even less access to care. Curbing that trend is another reason policy makers want to boost primary-care salaries. But that could mean reduced pay for some specialists. Analyst David Grande expects a hard fight.

Grande: That process has unfortunately really developed into a lot of infighting among doctors between specialties who have more political leverage against specialties who have less political leverage.

Specialists argue they deserve higher pay because they have more training and more costly malpractice insurance.

Andrew Warshaw is an official with the American College of Surgeons. He says there’s a shortage of surgeons, too, so it makes little sense to cut their compensation.

Warshaw: If you need a surgeon, there’s no substitute. If you’re in a car accident you may well need a trauma surgeon. If you’ve got a cancer you need a surgeon.

Most of the health reform bills being debated in Congress seek to expand the role of preventive care. Policy analysts say, one way or another, that will likely lead to bigger paychecks for primary care doctors.