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Primary care: Where do you stand on the pay scale?

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Ever wonder how much your primary care colleagues earn and how hard they work? Here's your chance to find out.

 

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Primary Care: Where do you stand on the pay scale?

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Choose article section...Five-year net income trend: Only pediatricians beat inflation What's happened to patient visits over the years? Where the money is for primary careDoctors in the South generally see more patients Net income reaches its peak in the early 50s in most fields......and that means mid-career—except for ob/gyns The gender gap persistsNo 40-hour workweeks hereHow level 3 office visit fees and payments differ—a five-year perspective For most primary care doctors, only a handful of managed care contracts How managed care involvement affects net income

Ever wonder how much your primary care colleagues earn and how hard they work? Here's your chance to find out.

By Anne L. Finger
Senior Editor

An extra $1,000 a month. That's what you could expect if you were an internist from Chicago starting a new job in Pennsylvania. If you were an FP making the same move, though, forget that geographical bonus: You'd be more likely to give up a few hundred dollars a month.

These are just two tidbits from our in-depth study of primary care specialties. The numbers come from the Medical Economics Continuing Survey, which polls MDs and DOs in office-based private practice.

Our latest figures show that internists and ob/gyns worked longer hours in 2000 than FPs and pediatricians, yet saw significantly fewer patients. Over the past 10 years, while internists' working hours and patient visits held steady, FPs shortened their workweek by 17 percent and saw patient visits drop from 142 a week to 128.

Both specialties enjoyed rising incomes over the five-year period between 1994 and 1999, though the increase for FPs has been twice as great, at just over 6 percent. That's nowhere near pediatricians' 13 percent gain, however. Overall, ob/gyns lead the primary care pack in net income. Internists, who were the second-highest-earning primary care specialists in 1994, have now fallen behind both FPs and pediatricians.

We chose level 3 office visits as a window to fees and reimbursements over the past five years. Internists made greater gains in payments for established patients, while FPs saw bigger increases for new patients. Both specialties' fees for new patient visits rose by comparable amounts in the past five years, while internists increased their fees for established patient visits slightly more. Internists' fees for both new and established patients are higher than FPs'.

Here are other highlights of our findings:

  • Internists' best bet for high income is in the East, where their median net was $133,850. Ob/gyns and pediatricians did best in the South, FPs and GPs in the Midwest.

  • FPs, internists, and GPs who participated in HMOs and PPOs reported higher earnings than colleagues who didn't participate.

  • Ob/gyns who kept away from HMOs reported $31,720 more net income than their peers who joined, and those who avoided PPOs reported $26,700 more. Ob/gyns' special relationship with their patients allows them to retain an independence from managed care that eludes other primary care specialists, suggests consultant David C. Scroggins of Clayton L. Scroggins Associates in Cincinnati. Women will stick with an ob/gyn regardless of which plans the doctor does or doesn't participate in, he explains.

If those who don't participate can maintain a busy practice, they receive a higher percentage of their standard fees than do their colleagues in managed care. And needing less staff for billing, they have lower overhead as well, explains Michael J. Wiley of Healthcare Management and Consulting Services in Bay Shore, NY.

Still, a greater percentage of ob/gyns (24 percent) participated in 10 or more HMOs or PPOs than did doctors in any other specialty.

  • Peak earnings occur between 50 and 54 years of age—unless you're an ob/gyn. Perhaps because the late-night hustle to deliver babies takes the energy of youth, earnings are highest when ob/gyns are aged 45 to 49.

  • The gender gap is smallest among ob/gyns (women earn $17,970 a year less than men) and largest among pediatricians ($27,430 less for women). This latter disparity is probably due to many women pediatricians' working fewer hours, Scroggins observes. "I think it will correct itself in eight to 10 years as the number of women pediatricians continues to increase, and those now home with their children begin working longer hours," he says. Wiley also believes hours worked, rather than gender in itself, explains the gap. "None of my clients is offering less money to women physicians," he says. "If anything, they're trying to attract women by offering them more."

Use the following tables and charts to compare yourself with other primary care physicians. For information on how the Continuing Survey was conducted, see "YIKES! Primary care earnings plummet" in our Sept. 18, 2000, issue.

 

Five-year net income trend: Only pediatricians beat inflation

 
1999
1994
% change, 1994-1999
FPs
$128,490
$121,060
6.1%
GPs
106,990
100,240
6.7
Internists
127,090
123,530
2.9
Ob/gyns
191,270
195,830
-2.3
Pediatricians
133,750
118,390
13.0
Consumer Price Index
 
 
12.4

 

What's happened to patient visits over the years?

 
Visits Per Week
1990
1995
2000
FPs
142
130
128
GPs
127
107
120
Internists
107
109
105
Ob/gyns
108
94
100
Pediatricians
151
140
127

 

Where the money is for primary care

 
Net income
East
Midwest
South
West
FPs
$127,340
$133,470
$132,620
$120,850
GPs
—*
124,070
104,200
102,150
Internists
133,850
120,560
129,560
124,620
Ob/gyns
194,370
196,320
206,090
167,020
Pediatricians
128,960
130,460
140,330
129,620

 

 

Doctors in the South generally see more patients

 
Visits per week
East
Midwest
South
West
FPs
125
125
148
112
GPs
—*
125
120
118
Internists
104
104
110
100
Ob/gyns
98
92
108
100
Pediatricians
116
120
145
125

 

Net income reaches its peak in the early 50s in most fields...

 
Age
35-39
40-44
45-49
50-54
55-59
60-64
70 and over
FPs
$123,060
$128,640
$144,620
$148,650
$136,500
$117,260
$101,820
GPs
—*
—*
115,610
—*
—*
106,880
103,140
Internists
115,250
141,640
133,890
147,790
141,910
120,410
108,730
Ob/gyns
184,140
213,050
215,800
208,820
167,590
—*
—*
Pediatricians
127,530
124,500
139,810
148,700
138,870
145,010
—*

 

...and that means mid-career—except for ob/gyns

 
Years in practice
1-5
6-10
11-20
21-30
More than 30
FPs
$108,360
$130,000
$131,050
$139,830
$114,880
GPs
—*
—*
108,310
106,130
106,590
Internists
117,850
125,570
145,060
124,030
120,950
Ob/gyns
171,690
209,750
198,470
195,670
145,130
Pediatricians
120,810
128,140
135,520
152,650
140,530

 

The gender gap persists

 

No 40-hour workweeks here

 

 

How level 3 office visit fees and payments differ—a five-year perspective

 
New patient (99203)
2000 fee
2000 actual payment
1995 fee
1995 actual payment
FPs
$90
$70
$67
$56
GPs
78
60
68
58
Internists
99
70
76
62
Ob/gyns
100
70
80
65
Pediatricians
80
60
65
52
 
Established patient (99213)
2000 fee
2000 actual payment
1995 fee
1995 actual payment
FPs
$55
$42
$44
$37
GPs
50
40
45
35
Internists
60
45
45
38
Ob/gyns
65
45
51
40
Pediatricians
55
41
44
37

 

For most primary care doctors, only a handful of managed care contracts

 
Number of contracted HMOs/PPOs
None
1-4
5-9
10 or more
Median
FPs
21%
46%
21%
12%
4
GPs
45
41
11
3
3
Internists
21
45
20
14
4
Ob/gyns
18
34
24
24
5
Pediatricians
11
44
25
19
4

 

How managed care involvement affects net income

 
In at least one HMO
No HMO participation
In at least one PPO
No PPO participation
FPs
$129,340
$122,540
$128,630
$122,830
GPs
119,290
83,290
120,120
91,630
Internists
131,670
120,530
136,880
110,810
Ob/gyns
186,620
218,340
183,420
210,120
Pediatricians
133,860
139,720
136,430
128,640

 



Anne Finger. Primary care: Where do you stand on the pay scale?.

Medical Economics

2001;6:140.

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