Physician Wages Across Specialties

Leigh, James; Tancredi, Daniel J.; Jerant, Anthony F; Kravitz, Richard L.

doi:10.1001/archinternmed.2010.350

Cited by 56 publications

(18 citation statements)

References 27 publications

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“…Poor income potential and limited job opportunities after graduation were 2 of the 3 top reasons for dissatisfaction among US adult nephrology fellows in a 2011 survey, 4 but earnings and employment data suggest that in reality, nephrology does not rank poorly in these 2 areas. 21,22 Of respondents who had considered pursuing nephrology in our survey, only 14% of non-nephrology fellows claimed to be influenced by monetary issues. This suggests that most respondents either did not perceive nephrology to be low paying or did not weight this factor heavily.…”

Section: Discussionmentioning

confidence: 87%

Why Not Nephrology? A Survey of US Internal Medicine Subspecialty Fellows

Jhaveri

Sparks

Shah

et al. 2013

American Journal of Kidney Diseases

117

115

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Background There is a decreased interest in nephrology such that the number of trainees likely will not meet the upcoming workforce demands posed by the projected number of patients with kidney disease. We conducted a survey of US internal medicine subspecialty fellows in fields other than nephrology to determine why they did not choose nephrology. Methods A web-based survey with multiple choice, yes/no, and open-ended questions was sent in summer 2011 to trainees reached through internal medicine subspecialty program directors. Results 714 fellows responded to the survey (11% response rate). All non-nephrology internal medicine subspecialties were represented, and 90% of respondents were from university-based programs. Of the respondents, 31% indicated that nephrology was the most difficult physiology course taught in medical school, and 26% had considered nephrology as a career choice. Nearly one-fourth of the respondents said they would have considered nephrology if the field had higher income or the subject were taught well during medical school and residency training. The top reasons for not choosing nephrology were the belief that patients with end-stage renal disease were too complicated, the lack of a mentor, and that there were insufficient procedures in nephrology. Conclusions Most non-nephrology internal medicine subspecialty fellows never considered nephrology as a career choice. A significant proportion were dissuaded by factors such as the challenges of the patient population, lack of role models, lack of procedures, and perceived difficulty of the subject matter. Addressing these factors will require the concerted effort of nephrologists throughout the training community.

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Section: Discussionmentioning

confidence: 87%

Why Not Nephrology? A Survey of US Internal Medicine Subspecialty Fellows

Jhaveri

Sparks

Shah

et al. 2013

American Journal of Kidney Diseases

117

115

View full text Add to dashboard Cite

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“…Overall, general pediatrics is one of the lower-compensated specialties based on hourly wages. However, general pediatrics ranks first for mean hourly wage among the three major primary care specialties (family medicine is second; internal medicine is third) [64]. A limitation to analysis and policy development that addresses the continuum of trainee decision-making is whether the available data from medical student, primary care, and pediatric subspecialty fellowship surveys can be generalized to the subspecialty of PR.…”

Section: Barrier 4: Insufficient Workforce Supply To Meet Demandmentioning

confidence: 99%

Policy challenges for the pediatric rheumatology workforce: Part I. Education and economics

Henrickson

2011

Pediatr Rheumatol

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For children with rheumatic conditions, the available pediatric rheumatology workforce mitigates their access to care. While the subspecialty experiences steady growth, a critical workforce shortage constrains access. This three-part review proposes both national and international interim policy solutions for the multiple causes of the existing unacceptable shortfall. Part I explores the impact of current educational deficits and economic obstacles which constrain appropriate access to care. Proposed policy solutions follow each identified barrier.Challenges consequent to obsolete, limited or unavailable exposure to pediatric rheumatology include: absent or inadequate recognition or awareness of rheumatic disease; referral patterns that commonly foster delays in timely diagnosis; and primary care providers' inappropriate or outdated perception of outcomes. Varying models of pediatric rheumatology care delivery consequent to market competition, inadequate reimbursement and uneven institutional support serve as additional barriers to care.A large proportion of pediatrics residency programs offer pediatric rheumatology rotations. However, a minority of pediatrics residents participate. The current generalist pediatrician workforce has relatively poor musculoskeletal physical examination skills, lacking basic competency in musculoskeletal medicine. To compensate, many primary care providers rely on blood tests, generating referrals that divert scarce resources away from patients who merit accelerated access to care for rheumatic disease. Pediatric rheumatology exposure could be enhanced during residency by providing a mandatory musculoskeletal medicine rotation that includes related musculoskeletal subspecialties. An important step is the progressive improvement of many providers' fixed referral and laboratory testing patterns in lieu of sound physical examination skills.Changing demographics and persistent reimbursement disparities will require workplace innovation and legislative reform. Reimbursement reform is utterly essential to extending patient access to subspecialty care. In practice settings characterized by a proportion of Medicaid-subsidized patients in excess of the national average (> 41%), institutional support is vital. Accelerating access to care will require the most efficient deployment of existing, limited resources. Practice redesign of such resources can also improve access, e.g., group appointments and an escalating role for physician extenders. Multidisciplinary, team-oriented care and telemedicine have growing evidence basis as solutions to limited access to pediatric rheumatology services.

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“…There are inequalities in the perceptions of career satisfaction, professional equity and daily distress levels between female and male physicians that need attention. Female physicians, in comparison to men, report earning less [10,25] , experience less control over patient load and more time pressure to see their patients and, simultaneously, state that they see more patients with psychosocial problems [25,26] . Further, female physicians experience additional stressors, like discrimination, lack of role models and support, and the challenge of balancing career and family spheres.…”

Section: Discussionmentioning

confidence: 99%

“…Since female physicians report higher percentage of complex patients [25] , less control on daily aspects of practice [26] , extra challenges to achieve work-life balance [5,6,9] and professional development [6,10] , alternative payment schemes should acknowledge these factors, providing the necessary flexibility to enhance their motivation.…”

Section: Figure 1 Error Bars Of the Three Dependent Variables By Paymentioning

confidence: 99%

“…Female medical school faculty perceive gender discrimination in promotions, allocations of space, access to administrative staff, and the assignment of graduate students [6] . There is evidence that female specialists are paid slightly less in comparison to male physicians [10] . In addition, it has been reported that new cohorts of female physicians tend to choose alternative payment methods [11] rather than the traditional fee-for-service (FFS) schemes.…”

Section: Introductionmentioning

confidence: 99%

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Latent gender inequalities in the well-being of physicians according to payment method for practicing medicine: a cross-sectional study

Peña-Sánchez

Lepnurm

Bermedo-Carrasco

2013

JHA

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Background: Female physicians face extra challenges in their career development and tend to choose salary or other forms of alternative payment plans (APP). Fee-for-service (FFS) and APP may affect the well-being of female and male physicians differently. Three measures of well-being are: levels of career satisfaction, professional equity, and daily distress. The objectives are to identify differences in the levels of career satisfaction, fulfillment-recognition equity, and daily distress of physicians by gender and payment method, and to assess interactions between these two factors. Methods:A cross-sectional study was conducted in 2011 with physicians practicing in the Saskatoon Health Region, Saskatchewan, Canada. Resident physicians were excluded from the study. Eligible physicians completed a survey, assessing levels of daily distress, fulfillment-recognition equity, and career satisfaction as dependent variables. A multivariate analysis of variance (MANOVA), using the Wilks' Lambda criterion, was conducted to study differences among the dependent variables by remuneration method and gender. Multiple comparisons were performed as post-hoc tests.Results: Nearly half (382) of the 794 eligible physicians completed the questionnaire; 37.2% were female. Half were remunerated by FFS, a quarter by APP, and the remainder by blended forms. Career satisfaction and fulfillmentrecognition equity were positively correlated to each other and daily distress was negatively correlated with both. According to the MANOVA results, the dependent variables were affected by gender but not by payment method, and there was no evidence of an interaction effect between payment method and gender. Women reported lower levels of career satisfaction (p=0.01) and fulfillment-recognition equity (p=0.01), and higher levels of daily distress (p=0.03). Conclusion:Female physicians reported poorer well-being than male physicians. In contrast, no differences in the well-being were found among physicians paid by APP, blended methods, and FFS schemes. Further cross-national studies are recommended to study potential effects of APP on the identified gender inequalities.

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Physician Wages Across Specialties

Cited by 56 publications

References 27 publications

Why Not Nephrology? A Survey of US Internal Medicine Subspecialty Fellows

Why Not Nephrology? A Survey of US Internal Medicine Subspecialty Fellows

Policy challenges for the pediatric rheumatology workforce: Part I. Education and economics

Latent gender inequalities in the well-being of physicians according to payment method for practicing medicine: a cross-sectional study

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