according to the latest survey by clinician job board LocumTenens.com.
In 2018, the average salary for a physician rose to $363,924 and the average salary for physician assistants (PAs) and nurse practitioners (NPs) rose to $122,973. The average physician’s salary has increased 16.5 percent since 2015, according to the report, which was based on an August 2019 survey. Salaries for physician assistants and nurse practitioners have fluctuated over the past few years, but have been on the rise since 2017, the report noted. Survey respondents were full-time, permanent practitioners, and the survey took into account annual salaries and bonuses.
Primary care physicians earned less than half of what orthopedic surgeons receive, and primary care nurse practitioners also earned less than other health care practitioners. In the survey, the salary for a primary care physician was the average based on those working in internal medicine, family practice, and pediatrics. But within this category, there were stark differences. Salaries for internal medicine rose by about 22 percent since 2016, while the average salary for family practitioners actually decreased by approximately 8 percent in 2018.
By contrast, orthopedic surgeons, who are at the top of the salary list, saw an average salary increase of 10 percent since 2016. Of those surveyed, most physicians were employed by hospitals, while most PAs and NPs worked in clinics, community centers, hospitals or group practices.
An Artificial Market
The discrepancy in earnings between specialists such as orthopedic surgeons and cardiologists and primary care physicians may reflect the realities of today’s artificial health care market.
Set fees for Medicare and Medicaid patients, for example, distort the health care market, as do the shadowy intricacies of provider networks and drug prices, say physicians.
“The long-standing earnings discrepancy between primary care physicians (family medicine, internal medicine, and most pediatrics) when compared to specialists is well known and undisputed,” said Beth Haynes, M.D., medical director at the Benjamin Rush Institute. “Some of the differences can be explained by the longer training and higher risk assumed by procedure-intensive doctor.”
Government health coverage, however, also plays a role, says Haynes.
“A significant role goes to Medicare’s administrative price setting, heavily influenced by the American Medical Association’s (AMA) Relative Value Scale Update Committee (RUC),” Haynes said. “It would be fascinating to know what incomes would be if we had market prices in medicine. The gap could be larger or smaller – we just don’t know in today’s system.”
Philip Eskew, D.O., J.D., founder of DPC Frontier, and policy advisor to The Heartland Institute, which publishes Health Care News also points an accusing finger at the AMA’s RUC.
“Primary care physician salaries have remained flat while other physician salaries increased over time due to the biased distribution and out-sized influence of the AMA’s RUC,” Eskew said. “There are 29 unelected physician members on the RUC and only five of these represent primary care.”
Eskew says third-party fee-for-service reimbursement is tied to those RUC recommendations.
“Rather than increase primary care salaries to reflect the demand and shortage, large hospital systems that accept Medicare argue that they are boxed in and cannot offer a salary above certain MGMA (Medical Group Management Association) percentiles because it will adversely increase their audit risk,” Eskew said.
Tomorrow’s Doctors Notice
Additionally, young doctors typically leave medical school heavily in debt and gravitate to higher-paying specialties that enable them to pay off their student loans quicker. This can lead to a shortage of lower-earning primary care physicians, particularly in sparsely populated rural areas.
“Medical students will continue to forego these specialties for more lucrative specialties when this sort of disparity exists,” said Chad Savage, M.D., founder, YourChoice Direct Care, and policy advisor to The Heartland Institute, which publishes Health Care News. “You get what you pay for. If you want more orthopedists, you will get them by paying them more. On the contrary, there is a shortage of primary care physicians and psychiatrists. If you want more of them, you can achieve this by valuing them in the payment model.”
Savage says it comes down to who sets the salary valuations in particular fields of practice.
“Currently, the value is determined by the centrally controlled Medicare System,” Savage said. “In a free market system, the health care consumer determines the value of these specialties and thus, their relative prevalence.”
2019 Salaries for Physicians and Health Care Providers
Orthopedic surgeons, $539,464
Critical care, $376,090
General surgeons, $372,500
Emergency medicine, $360,433
Primary Care, $245,146
Certified nurse anesthesiologists, $202,244
Emergency medicine physician assistants, $166,194
Emergency medicine nurse practitioners, $142,857
Psychiatric nurse practitioners, $137,993
Critical care nurse practitioners, $134,850
Hospitalist nurse practitioners, $128,532
Primary care nurse practitioners, $118,034
Bonner R. Cohen, Ph.D.([email protected]) is a senior fellow at the National Center for Public Policy Research and a senior policy analyst with the Committee for a Constructive Tomorrow.