Specialist and primary care pay per hour

Authors of a recent study from the Archives of Internal Medicine are unlikely to endear themselves to specialists.

As reported by Reuters, and provocatively titled, Do specialist doctors make too much money?, the study gives a per-hour breakdown of how much doctors make.

I think this is a good approach, since annual salary figures do not account for the number of hours doctors work — and in the case of primary care doctors, this includes uncompensated time doing paperwork and other bureaucratic chores.

Here’s what they found:

… the lowest wages — amounting to $60.48 an hour — [were] paid to primary care physicians.

In other broad categories of practice, surgeons took home the highest average hourly wage of $92. Internal medicine and pediatric docs earned about $85 an hour, the researchers report in the Archives of Internal Medicine.

Looking at salaries among 41 specific subspecialties, however, they found neurologic surgery and radiation oncology to be the most lucrative at $132 and $126 per hour, respectively. These were followed by medical oncologists and plastic surgeons, both making around $114 per hour; immunologists, orthopedic surgeons and dermatologists also took in more than $100 an hour. At the low end of specialist pay, child psychiatrists and infectious disease specialists made around $67 an hour.

Of course, regular readers of the blog know that health care reform will do little to decrease the disparity. The pay raises that will be coming to primary care will be far too little to change the perception that, in the United States, specialists are more valued by far.

Lead researcher J. Paul Leigh is blunt about how to solve the problem — and probably will endure the wrath of specialist physicians nationwide:

Some of the proposed health care reform laws would increase wages for primary care physicians, noted Leigh. But he doesn’t think that is enough. He suggests cutting wages of specialists too.

“Not only are primary care physicians undervalued by society,” Leigh said, “but the specialist is overvalued and overcompensated, while not really adding much bang for the buck as far as public health is concerned.”

Everyone acknowledges that primary care is undervalued in this country. 80% of doctors, in fact, support a pay raise for beleaguered generalists. But when asked if specialists should receive a 3% pay cut to offset the raise, less than 40% supported that idea.

And that’s why primary care will continue to suffer for the foreseeable future.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • everyman

    ER makes 150 -200/hr, it’s also very intense, radiology must be pretty up there as well, primary care can be very lucrative if ancillary services are offered

    • http://www.physiciandispensingsolutions.com My2Cents

      I agree with everyman. Primary care physicians just have to be more creative in their business approach and seek out programs that offer ancillary income opportunities. There are several turn-key programs like physician dispensing, drug toxicology testing, and DME that are very inexpensive to begin and can be very profitable.

  • anonymous

    Why does it have to be a zero sum game? These posts consistently come across as petty. The incessant whining, and not just for more money, but the childish and petulant “He/she makes too much! I deserve some of his/her money. I’m just as valuable!” is beyond unbecoming. While we are on the topic of making arbitrary value judgements, why not decrease primary care earnings to increase CNA pay – or dog walker pay, for that matter? Moreover, why not decrease ivory-tower economist earnings, just because?

    To me, the only provocative point in this post is this comparison – $132 vs. $60.48 for hourly neurosurgery vs. primary care earnings, or a little more than double. Of course, residency length is twice as many years and the work is inherently more prone to malpractice exposure. These earnings numbers are far from the claims of 3x or 4x earnings differences that are regularly cited.

    • r watkins

      The figures do seem low across the board, don’t they?

      You ask:

      “Why does it have to be a zero sum game?”

      Unfortunately, that’s what it’s been for the past 15 years, with the RUV/SGR system that has been used to deliberately keep primary care pay low and specialist pay high.. It’s no surprising that many primary care docs feel that they’ve been on the short end of an increasingly short stick for a long time.

    • http://www.aneurysmsupport.com/ Mike

      As a non-medical professional looking in it often seems that these articles pitting primary care physicians vs. specialist is almost an attempt to instigate class warfare among doctors.

  • Max

    Don’t go into medicine for the money, kids. You will earn what you make, no question about it. You’ll always have a job though which is a plus.

  • jsmith

    The information superhighway has destroyed primary care because med students now know how much of a better deal specialties are. When I went to med school in the early ’80s most of the clued-in students had docs in the family and so made a beeline for the money-and-lifestyle jobs. A lot of the rest of us but-he-don’t-know children wound up in PC.
    Now anyone with a computer knows the score. Also, of course, salary and job effort discrepancies have worsened.

  • http://www.BocaConciergeDoc.com Steven Reznick MD FACP

    The problem with all these articles is that they are always pitting primary care vs specialty care. It should not be an us vs. them game even though the payment system is set up that way currently. When a new procedure is developed , a Medicare payment review group , usually comprised of academic specialists who practice that specialty, determine the fee for that procedure. Private insurers create their fee as a percentage of that determination. By and large these initial estimates and allowances are always off base and over valued. The problem is that physicians in practice and coming out of training build their practice budget and ultimately their home budget off these reimbursement figures for new procedures. Then all of a sudden several years into this process it is determined that a procedure is over valued and the reimbursement is abruptly reduced. That isnt fair. Primary care physicians are under paid. We need more family practitioners and general internists . Their pay and benefits need to be bumped up. I know very few PCP’s who expect to have an increase in reimbursement for their services taken out of the pocket of their colleagues in other areas of medicine. We realize the time, energy, risk that go into practicing medicine and surgery. As the technology evolves we need the payment review committees to value the new procedures accurately from the start . Any reduction in payment for procedures needs to be a gradual one if any because physician’s livelihoods and long term commitments are difficult to safely abruptly change.

  • chloe

    Primary care docs get to spend 15 minutes on a patient encounter, most of which is administrative. The rule has become ‘only one problem per visit,” leaving it to the patient to triage their issues. The only type of practice this allows is making a problem list, and refer to a specialist.

    Give primary care docs more time — and pay them — and there will be less work for specialists.