Policy

Physician stress, mental effort doesn’t vary much across specialties

A new study has found that the amount of stress and mental effort felt by […]

A new study has found that the amount of stress and mental effort felt by physicians doesn’t vary much across specialties, and represents another argument for decreasing the compensation gap between primary care and specialty doctors.

University of Cincinnati (UC) researchers used various work-intensity measurement tools to gauge the level of mental effort and stress experienced by four different types of doctors: family physicians, general internists, surgeons and neurologists, according to a statement from UC. The study was published in the journal Medical Care.

“A physician’s work can be assessed by the time required to complete it and by the intensity of the effort, which is central to properly valuing the services being provided,” said Ronnie Horner, chair of UC’s public health sciences department and lead investigator on the study

That statement, and particularly the part about “valuing the services,” could be music to the ears of those who advocate for higher primary care salaries. The compensation gap between specialists and primary care doctors is wide, despite a widely reported national “shortage” of primary care physicians as well as the generally recognized importance of primary care to improving the nation’s health.

For example, radiologists last year earned median compensation of about $471,000, while doctors in internal medicine earned median compensation of about $205,000, according to the Medical Group Management Association. That trend of much higher pay than primary care holds across most specialties, such as orthopedic surgery and cardiology.

“It is clear that the pay you can expect as a physician has little to do with how hard you work, how long you train, or how stressful or difficult your work is, and everything to do with whether you perform procedures that are highly compensated,” wrote Dr. Edward Pullen, a family physician, on the popular KevinMD blog last year.

A recent Columbia University study showed that the U.S. undervalues primary care relative to other industrialized countries. In the U.S., primary care doctors earned about 42 percent of what orthopedic surgeons did. In Canada, France and Germany, primary care physicians earned at least 60 percent of orthopedic surgeons’ compensation. (The study also found that U.S. physicians’ compensation across all specialties, including primary care, was significantly higher than in other industrialized nations.)

The good news for primary care advocates is that there already seems to be at least some realization by policy makers about potential problems in pay disparity. Last year’s federal health reform law contained a provision raising Medicare reimbursements to primary care physicians by 10 percent, a small amount, but a start nonetheless.

The UC study was funded by a laundry list of medical associations: the American Academy of Neurology, the American Academy of Dermatology, the American Psychiatric Association, the American Academy of Family Physicians, the American Academy of Allergy, Asthma and Immunology, and the Joint Council of Allergy, Asthma and Immunology.

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