Session: Issues in the Physician Market
Room: Upson 117
Time: Tue 13:15-14:45

Presenter: Martey Dodoo (American Academy of Family Physicians. )

Discussant: Darren GrantSam Houston State University

Abstract

Background:
Past studies have shown a clear and widening gap between the expected incomes of primary care physicians and sub-specialist physicians. More than a decade ago they also showed that students could expect poorer financial returns on their investment in medical education if they chose primary care careers instead of non-primary care, law or dentistry. Given the current push in national health care reform legislation to provide more primary care physician services, the question is: do these findings still hold or have they changed (worsened or improved)?

Objectives:
To estimate the return on investments (ROI) in primary care and the return on non-primary care education. To demonstrate how the disparity on the return on investment between primary care and non-primary care education could exacerbate current policy options.

Data and Methods:
Obtained data from the American Association of Medical Colleges (AAMC) on the cost of medical school and residency training. Also obtained data on alternates to physician education, the cost of professional practice and certification, and physician income from the MGMA, and the cost of living from the U.S. Department of Commerce. Computed the average hours-adjusted net present value (NPV) for physicians from 1980 to 2004, and compared education of primary care physicians to that of non-primary care physicians. Assessed the implications of the results to current health care reform legislations.

Results:
The calculated net present value (NPV) for educating primary care physicians was $29.58 per adjusted-hour in 2000-2004 compared to $12.54 per adjusted-hour in the eighties. In comparison, the NPV for educating non-primary care physicians was $78.45 per adjusted-hour in 2000-2004 compared to $36.58 per adjusted-hour in the eighties. These results imply over a lifetime a difference in total earnings between primary and non-primary care physicians of from $1.8 million in 1980-1989 to $4.1 million 2000-2004. The results further showed that the disparity on the return on educational investment between primary care and non-primary care physicians could exacerbate the current health care reform policy options.

Conclusion:
Primary care continues to receive a declining popularity among U.S. medical students. The widening of the ROI gap between primary care and subspecialty physicians over the three-decades suggests that the findings from earlier studies (done in the early 1990’s) still hold — that primary care is not only competing with subspecialty care for the best and brightest students, but with other professions as well.

Key Terms

Physicians, Education, Investment

Authors:

Martey Dodoo (AAFP Center for Policy Studies)