Primary care physicians may earn lowest hourly wages

Clinician's wages appear to vary significantly across physician specialties and are lowest for those in primary care, according to a report in the October 25 issue of Archives of Internal Medicine.

"Numerous studies have documented substantial income disparities between primary care and other physician specialties. Such disparities may impede health care reform by undermining the sustainability of a vigorous primary care workforce," the authors write as background information in the article. Comparing clinicians' annual income may not be the best measure of the value placed by society on each specialty, because it does not account for variations in the number of hours worked. "Physician wages (earnings per hour) may offer a more useful and intuitive metric for relative valuation of specialties."

Using data from a representative sample of 6,381 physicians providing patient care in 2004 to 2005, J. Paul Leigh, Ph.D., and colleagues at the University of California Davis School of Medicine, Davis, compared wages across four broad specialty categories: primary care, surgery, internal medicine and pediatric subspecialties, and other. They also assessed wages among 41 specific specialties along with differences based on demographic, geographic and market variables.

Overall, clinicians earned an average annual income of $187,857 and worked an average of 53.1 hours per week. When compared with those of primary care specialists, wages were 48 percent higher among surgeons, 36 percent higher among internal medicine and pediatric subspecialists and 45 percent higher among clinicians in other specialties.

In the analysis of 41 specific specialties, neurologic surgeons ($132 per hour) and radiation oncologists ($126 per hour) earned the highest wages. The specialists who earned the least per hour were those in internal medicine and pediatrics ($50) and other pediatric subspecialists ($52).

When compared with the reference group of general surgeons, whose hourly earnings were close to the median or midpoint at $86, wages were significantly lower for internal medicine and pediatrics combined ($24 less), internal medicine ($24 less), family medicine ($24 less) and other pediatric subspecialties ($23 less). Physicians in neurologic surgery, radiation and medical oncology, dermatology, orthopedic surgery and ophthalmology all earned $17 to $50 more per hour than general surgeons.

These differences in wages did not change when factors such as age, race, sex and geographic region were considered. "Some might interpret these findings as reflecting labor markets responding to supply and demand," the authors write. "However, market forces are constrained in the regulated physician environment. In addition, experts have projected substantial shortfalls in numbers of primary care physicians in the near future, a potential threat to the health of the American public."

"The primary care wage gap was likely conservative owing to exclusion of radiologists, anesthesiologists and pathologists," they conclude. "In light of low and declining medical student interest in primary care, these findings suggest the need for payment reform aimed at increasing incomes or reducing work hours for primary care physicians."