Primary Care, Subspecialist Physician Payment Gap Narrowing - Are you listening?

The Family Medicine Revolution is happening before our eyes.  The payment gap between primary care and specialties is shrinking - is anybody listening?

According to a recent Medscape article titled "CMS Proposes Primary Care Raises Funded with Specialist Cuts," Family Medicine is set to get the highest raise of all specialties with a 7% jump.  This is great news when considering Medical Group Management Association (MGMA) recently reported that, when considering 2011 statistics, primary care docs saw a 5% increase in pay compared to the previous year.

CMS administrator Marilyn B. Tavenner states that "helping primary care doctors will help improve patient care and lower health care costs long term."  The Vermont Medical Society produced an article that explains the proposed rule by CMS in a bit more depth.  In an AAFP News Now article published today, 11JULY2012, states that the proposed rule would pay for non face-to-face care as well as care-coordination.

An article by MedPage Today discusses the potential investment in primary care-coordination during the 30 days after a patient is discharged from a hospital stay as an investment worth making - getting patients appropriate follow-up to prevent bounce-backs, readmission rates, and other costly inefficiencies that go along with inadequate primary care follow-up, specifically with a family doctor.  I say specifically a family doctor because this is also a statistically significant data point in recent studies by the Graham Center, not just because it is a biased opinion.

One of the main driving forces for medical student interest for primary care and Family Medicine as a specialty is the gap between reimbursement for services provided and salary achieved for specialists compared to primary care.  This of course was carefully outlined in the Council on Graduate Medical Education's 20th Report, "Advancing Primary Care."   Of course, it does not take a formal report to understand that a difference in pay that averages about $3.5 million over a lifetime can be quite influential to a medical student set to graduate with greater than $200,000 in student loans.  This is not anecdotal, it has been extensively researched by COGME, the Graham Center, and a number of other studies.

Look no further than the military in regards to how payment disparities, or lack thereof, can lead to the production of more primary care doctors.  Take into consideration the annual incentive pay between the different specialties within medicine.  The largest payment disparity between a military family doctor with the same number years of service, rank and the same number of dependents as a military doctor who hit the ROAD (Radiology, Ophtho, Anesthesia, Dermatology) will usually be about $20,000 per year.  Compare that with the civilian world where the disparity is, on average, about ten times that amount.  It is no wonder why the Uniformed Services University of the Health Sciences continues to rank in the top 10 in matching its students to Family Medicine Residencies.  Is this the way that civilian medicine should go in regards to paying physicians?  Probably not.  However, it is interesting how the military world values a foundation in primary care and how it values all of its doctors appropriately within its single-payer system.  

So, where are we heading?  Are new CMS proposals going to make a difference?  Are medical students listening?  Are current family doctors who persuade medical students away from the specialty changing their message?  Will the American Academy of Family Physicians Task Force on Primary Care Valuation truly influence CMS?  Are the new increases a way in which CMS did actually in fact take the AAFP's recommendations rather than the American Medical Association's Relative Value Update Committee's consistently secretive, non-transparent valuation of specialists services?  Only time will tell.

Something that should be listened to and resonated around the country originates from a recent tweet by the American Academy of Family Physicians Family Medicine Interest Group account states: "A new study shows compensation of primary care docs (>$200,000) grew at a faster rate than specialists in the last 5 years."  Now that is something worth talking about.