AAFP wants change in RUC composition

July 25, 2011

To increase parity between specialists and primary care providers (PCPs) and address the growing shortage of PCPs, the American Academy of Family Physicians (AAFP) has called on the AMA/Specialty Society Relative Value Scale Update Committee (RUC) to change its structure to give greater representation to primary care fields.

To increase parity between specialists and primary care providers (PCPs) and address the growing shortage of PCPs, the American Academy of Family Physicians (AAFP) has called on the AMA/Specialty Society Relative Value Scale Update Committee (RUC) to change its structure to give greater representation to primary care fields.

The AAFP wants the RUC to change its composition by adding four seats to the board for PCPs-one each for the AAFP, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association-and eliminating three rotating subspecialty seats.

A letter from AAFP board chairwoman Lori Heim, MD, to the RUC in June also suggested adding an additional four seats, three for external representatives, such as consumers or health plans, and one for geriatrics. Currently, the RUC has 29 members.

Internal medicine physicians' compensation rose more than 4% to a median of $205,379, and family practice (without obstetrics services) saw a nearly 3% increase to a median pay of $189,402.

On the other hand, orthopedic surgeons had a median compensation of $514,659, representing a 3.71% increase during that time.

PCPs earn $3.5 million less in total lifetime income than subspecialists, according to a report sponsored by the AAFP, driving medical students to shun general internal medicine, family practice, and other primary care fields. Medical students today are half as likely to choose primary care as they were 30 years ago and are 20% less likely to practice in a rural area.

That adds up, and medical students are well aware of the disparities in earning potential.

Already, rural and low-income communities are hard hit by the shortage of PCPs, which the Institute of Medicine estimates exceeds 16,000-and the problem is likely to become more acute with the implementation of the Patient Protection and Affordable Care Act.

Where you live also affects your pay compared with specialty physicians. The MGMA survey found that specialists out-earned PCPs by nearly 190% in the South in 2010.

Compensation was closest in the East, where specialists brought home just under 160% of a PCP's pay.

The RUC was formed by the American Medical Association to advise the Center for Medicaid and Medicare Services (CMS) on the relative value of physician services.

CMS uses the recommendations to determine physician payments for specific codes. Many private health plans follow CMS' lead on payments, so the RUC's recommendations have a tremendous potential impact on physician earnings.