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Salary growth lagging for primary care doctors

By Genevra Pittman

NEW YORK (Reuters Health) - Despite rising spending on health care in the United States, primary care doctors don't seem to be reaping the rewards on their paychecks, a new study suggests.

The findings could have implications for what some predictions say will be a primary care shortage in some parts of the country in the coming years.

Researchers found that since the late 1980s, the average doctor's earnings have grown more slowly than the salaries of other health professionals, such as pharmacists, dentists and registered nurses.

"It is possible that there are some specialties that have done extremely well in the past 10 or 15 years," said health policy researcher Amitabh Chandra from Harvard University in Cambridge, Massachusetts, who worked on the study.

But, "In terms of the experience of the median doctor, the median doctor is not at the heart of all the cost growth we're seeing in America." And that may have implications for the primary care field in the future, he noted.

For their study, Chandra and his colleagues analyzed data from a nationally-representative survey of Americans' occupations and earnings conducted every year between 1987 and 2010. Each round included people older than 35 from 60,000 different households.

Over the 14-year study, 30,556 health professionals were surveyed, including 6,258 doctors.

The researchers found that between 1987-1990 and 2006-2010, the median doctor's annual earnings grew from $143,963 to $157,751 - a difference of 9.6 percent. That was after taking into account any salary differences based on gender, age and location.

In comparison, the average pharmacist's earnings increased by 44 percent, from $70,341 to $101,279, and the average dentist's by 23 percent, from $105,511 to $129,795, the researchers reported Tuesday in the Journal of the American Medical Association.

Looking closer, the study team found that doctors' salaries grew between 1987-1990 and 1996-2000, but then were stagnant over the next decade - a time when other health professionals continued to get bigger paychecks.

Because the earnings reflect pay for doctors in the middle of the salary pack, Chandra said the slow growth probably represents patterns for primary care doctors rather than specialists - and earnings for some "procedure-driven specialties," such as cardiology, may have grown a lot.

Medicare payment cuts, as well as tougher bargaining by insurance companies, may be partly to blame for the "sluggish" growth in the primary care field, he added.

THE WHOLE PACKAGE?

In addition, more women and minorities are becoming doctors - and research has suggested they make less money than white, male physicians, said Bob Konrad from the University of North Carolina at Chapel Hill, who has studied doctor salaries.

He said the new findings may also not tell the whole economic story for primary care doctors.

Recently employers have started offering to pay off more of new doctors' college and medical school debt as a way of luring top candidates, he said - but such financial benefits wouldn't show up on their paychecks.

"Going forward, thinking about physician incomes, you have to think about the whole package," Konrad, who wasn't involved in the new study, told Reuters Health.

But Chandra said the study may have implications for some parts of the U.S. that are already facing a shortage of primary care doctors.

"If as a country we want more people to go into primary care, this anemic, jaundiced earnings growth is not going to be a motivator to get people to join primary care," he told Reuters Health.

One profession not covered by the new research, Konrad pointed out, is wage workers such as home health aides.

"That's a big part of the healthcare workforce and growing much faster than many other occupations," he said. What's more, "The hourly wage of a home health aide has been going down every year for the last 10 years… Half the people in the health sector are in the bottom half (of American workers) - they're making less than $40,000 a year."

SOURCE: http://bit.ly/JjFzqx Journal of the American Medical Association, online November 27, 2012.

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