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

March 19, 2001

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-careerexcept for ob/gyns The gender gap persistsNo 40-hour workweeks hereHow level 3 office visit fees and payments differa 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 ageunless 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-careerexcept 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 differa 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.