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AAFP President Refutes Claims That Primary Care Physician Incomes Contribute to High Health Care Costs
"The conclusion that income earned by primary care physicians is driving up the cost of health care in the United States completely ignores the systematic flaws that, together, increase costs," said AAFP President Roland Goertz, M.D., M.B.A., of Waco, Texas, in a Sept. 8 letter submitted to the editor of The New York Times.
Goertz said the article and the study itself notes that Americans make more use of hip replacements than office visits -- a finding that "points to an imbalanced system in which highly invasive medical procedures are used more often than efficient, effective preventive primary care."
"(The study) also notes that American primary care doctors earn 42 percent of what subspecialists earn, compared to 60 percent earned by primary care physicians in other countries," Goertz said. "As a consequence, American students gravitate toward higher income subspecialties, and the U.S. health care system precariously relies on an overabundance of subspecialty care and a shortage of primary care, a situation that clearly contributes to fragmentation, duplication and other factors that drive up costs."
- The AAFP has forcefully rebutted a Sept. 7 article in The New York Times that claims primary care physician fees and incomes are a major driver of the nation's overall health care costs.
- The article is based on a study published in Health Affairs that compares physician fees for primary care and orthopedic physicians in the United States and several other countries.
- According to a letter to the editor submitted to The New York Times, AAFP President Roland Goertz, M.D., M.B.A., said concluding that primary care physician income is driving up the cost of health care in the United States ignores the systematic flaws in the U.S. system.
Goertz cited an article written by Benjamin Brown, M.D., titled "The Deceptive Income of Physicians," that contends U.S. physicians are not overpaid given the investment in time and education costs to become a physician and the amount of hours they work throughout their careers. In fact, said Goertz, according to Brown's calculations, the adjusted net hourly wage for an internal medicine physician is $34.46, while the adjusted net hourly wage for a high-school teacher is $30.47.
Goertz stressed that there are significant differences in health care systems, depending on the country. "The U.S. system is out of balance with too much dependence on subspecialists and not enough value on primary care," said Goertz. "If we rebalance our system on primary care -- as the other countries have done -- we will see less cost due to prevention of conditions that require subspecialist care, such as hip replacements."
Miriam Laugesen, Ph.D., the lead author of the Health Affairs article on the study, said in a press release that "for decades, policymakers and medical leaders in this country have debated financial incentives to spur more doctors to become primary care physicians. Our work shows that continuing attention needs to be paid to the difference in payments across specialties and how we can get better value for those expenditures," said Laugesen.
In an interview with AAFP News Now, Laugesen called for ongoing attention to primary care physicians, saying that "when primary care incomes are lower, it is one factor that discourages people from choosing primary care as their specialty."