Sources of U.S. physician income: the contribution of government payments to the specialist-generalist income gap.
BACKGROUND
Physician income varies threefold among specialties. Lower incomes have produced shortages in primary care fields.


OBJECTIVE
To investigate the impact of government policy on generating income differentials among specialties.


METHODS
Cross-sectional analysis of the 2004 MEPS.


METHODS
For outpatient care, total payments made to 27 different types of specialists from five types of payers: Medicare, Medicaid, other government (the Veterans Administration and other state and local programs), private insurance, and out-of-pocket payments. For inpatient care, aggregate (i.e., all-specialty) inpatient physician reimbursement from the five payers.


RESULTS
In 2004, physicians derived 78.6% of their practice income ($149,684 million, 95% CI, $140,784 million-$158,584 million) from outpatient sources and 21.4% of their income ($40,782 million, 95% CI, $36,839 million-$44,724 million) from inpatient sources. Government payers accounted for 32.7% of total physician income. Four specialties derived > 50% of their outpatient income from public sources, including both the lowest and highest paid specialties (geriatrics and hematology/oncology, respectively).


CONCLUSIONS
Inter-specialty income differences result, in part, from government decisions.
Lasser
Karen E
KE
Department of Medicine, The Cambridge Health Alliance and Harvard Medical School, Cambridge, MA 02139, USA. klasser@challiance.org
Woolhandler
Steffie
S
Himmelstein
David U
DU
D014487:Centers for Medicare and Medicaid Services, U.S. / Q000191:economics; D004470:Economics, Medical; D018588:Fee-for-Service Plans / Q000191:economics*; D005251:Fees, Medical; D006801:Humans; D010820:Physicians / Q000191:economics*; D013038:Specialization / Q000191:economics*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics