I’ve written before that there’s a good possibility that tensions between primary care doctors and their specialist brethren will get worse.

The issue comes down to pay. Congress, rightly, is trying to find ways to better compensate primary care physicians, but most proposals do so at the expense of specialists.

In an article from Investor’s Business Daily, most of the bills circulating through Congress call for a 10 percent increase in primary care pay. Where is that money going to come from?

Ideally, it shouldn’t come from specialists, and any such suggestion is meeting the predictable response:

About half of the funding for the bonuses comes from across-the-board cuts in the fees Medicare pays for nonprimary care.

Specialists, naturally, oppose this course of treatment. The Alliance of Specialty Medicine sent a letter to Baucus saying that its members could not “support your manager’s amendment that would provide additional payments to primary-care physicians at the expense of specialists … we support (the Kyl Amendment) and other proposals to ensure that any primary-care bonuses are not at the expense of specialty care.”

But it’s going to be difficult to expand the pie, especially with the fiscal environment facing reform. Politicians would like nothing else but to see physician groups snipe at each other. Divide and conquer, as they say.

I think it will take more than money to convince medical students to pursue primary care as a career, however. A 10 percent pay raise by itself isn’t going to do it, with these students graduating with mortgage-sized school loans. The work environment and bureaucratic burden will have to improve as well. Here’s my quote in the piece:

. . . the problem goes beyond financial.

“Money aside, there has to be more done to improve the work environment for primary-care doctors,” he said. “The paperwork requirement is onerous, and doctors find frustrating the restrictions both Medicare and insurance companies impose on the doctor-patient relationship.”