Managed Care

Blame Medicare for primary care shortage?

Government overpays specialists relative to primary care physicians and thereby exacerbates the shortage of primary care physicians, according to researchers at the Cambridge Health Alliance and Harvard Medical School. The study, released online by the Journal of General Internal Medicine, will be printed in September.

The data are from the 2004 Medical Expenditure Panel Survey, which estimates expenditures and utilization of health services. Researchers found that government payers accounted for 32.7 percent of total physician income and that four specialties (geriatrics, hematology-oncology, nephrology, and rheumatology) derived more than half of their income from public sources.

Karen E. Lasser, MD, MPH, assistant professor of medicine at Harvard Medical School and lead author, says, “Public payers account for quite a bit of the income gap between specialists and primary care doctors. You can’t just attribute it to a free market economy. It appears that government policy may underlie some of the differences in pay.”

She notes that private insurers tend to follow Medicare payment rates. If there were less disparity in rates, “It might help improve the primary care shortage.”

Share of physicians’ outpatient revenues from various payers

Source: Lasser KE, Woolhandler S, Himmelstein DU. Sources of U.S. physician income. The contribution of government payments to the specialist-generalist income gap. J Gen Intern Med. 2008: Published electronically ahead of print.

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