Trends in Compensation for Primary Care and Specialist Physicians After Implementation of the Affordable Care Act

Hsiang, Walter; Gross, Cary P.; Maroongroge, Sean; Forman, Howard P.

doi:10.1001/jamanetworkopen.2020.11981

Cited by 11 publications

(15 citation statements)

References 3 publications

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“…8 Our findings are supported by a recent report showing primary care compensation growth outpacing specialty care compensation growth following the ACA. 13 These results suggest that the US health policy environment of the past decade (2011-2019) may have mitigated the steady erosion of primary care relative to specialty care in the United States in the preceding decade (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). While US medical student interest 14 and specialty income for primary care still lags behind specialty care (the 2019 median income was $246,092 for primary care versus $456,450 for specialty care), how much and which policy provisions contributed to our observations deserves further investigation.…”

Section: Discussionmentioning

confidence: 89%

US Primary Care vs Specialty Care Trainee Positions and Physician Incomes: Trends From 2001 to 2019

Royce

Jones

Muralidhar

et al. 2021

Journal of Graduate Medical Education

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Background Much of the Affordable Care Act (ACA) and subsequent US health care policies were designed to address deficiencies in health care access and enhance primary care services. How residency positions and physician incomes have changed in the post-ACA era is not well characterized. Objective We evaluated the growth of US trainee positions and physician income, in the pre- vs post-ACA environment by specialty and among primary care vs specialty care. Methods Total resident complement by specialty and year was extracted from the National Graduate Medical Education (GME) Census and stratified into primary care vs specialty care. Median incomes were extracted from Medical Group Management Association surveys. Piecewise linear regression with interaction terms (pre-ACA, 2001–2010, vs post-ACA, 2011–2019) assessed growth rate by specialty and growth rate differences between primary care and specialty care. Sensitivity analyses were performed by focusing on family medicine and excluding additional GME positions contributed by the introduction of the 2015 single GME accreditation system. Results Resident complements increased for primary care (+0.16%/year pre-ACA to +2.06%/year post-ACA, P < .001) and specialty care (+1.49%/year to +2.07%/year, P = .005). Specialty care growth outpaced primary care pre-ACA (P < .001) but not post-ACA (P = .10). Family medicine had the largest increase in the pre- vs post-ACA era (-0.77%/year vs +2.09%/year, P < .001). Excluding positions contributed by the single GME accreditation system transition did not result in any statistically significant changes to the findings. Income growth increased for primary care (+0.84%/year to +1.37%/year, P = .044), but decreased for specialty care (+1.44%/year to +0.49%/year, P = .011). Specialty care income growth outpaced primary care pre-ACA (P < .001), but not post-ACA (P = .22). Conclusions We found significant growth differences in resident complement and income among primary care versus specialty care in the pre-/post-ACA eras.

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Section: Discussionmentioning

confidence: 89%

US Primary Care vs Specialty Care Trainee Positions and Physician Incomes: Trends From 2001 to 2019

Royce

Jones

Muralidhar

et al. 2021

Journal of Graduate Medical Education

View full text Add to dashboard Cite

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“…The consequences of this technologic ascent are the specialization and sub-specialization of services, and therefore the inevitable fragmentation of care . This, in turn, has lent itself to the subconscious tendency, in the minds of provider and profession, to “fragment” patients themselves, abrogating the patient’s wholeness in the pursuit of the healing of his “parts.” That remuneration for subspecialty and procedural-based services far exceeds that for generalists and non-proceduralists naturally facilitates the trend (Hsiang, etc. al, 2020).…”

Section: Dehumanization Of the Clinicianmentioning

confidence: 99%

The Trilogy of Health Care: Caring and Healing of the Clinician

Perkins

Roberts

2021

Linacre Q

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Today, more than we are aware of in the history of health services in the United States, is the critical need to reclaim and apply the core values and principles that inspired physicians and nurses to respond to their original call become consolers and healers of the sick and those in distress, and to refocus our attention on the person of the healer. In clinical practice today, we are endowed with enormously effective interventions that were unimaginable only a few decades earlier. In light of the fund of knowledge, clinical competencies, and technological advancements that we bring to bear in our experience in caring for our patients, the learning curve is never flat, never complete, and never static. Newer, safer, and more effective interventions in the cure of illnesses, management to relieve stress, moderate fear of surgery, and to promote healing that often lead to early discharge and return to normal activities of daily living are readily available in clinical practice. Yet, there are looming threats that compromise the person of clinician, for example, dehumanization, consumerism, commodification, and fungeability of the human person. This article will describe the Trilogy of Health Care: Caring and Healing of the Clinician and its application to the care and healing of physicians and nurses as they accompany one another in caring for a world in need of healing and hope.

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“…avoiding cremation costs, which are typically covered by body donation programmes) contributed to their motivation to will their body 11 . Although the study did not look at the impact of socioeconomic status, physicians may be partially shielded from the influence of economic factors due to their higher‐than‐average lifetime earnings 12 . However, this is not universally true for those within other well‐compensated professions, and financial considerations were found to be secondary to other motivating factors 8,11,13–15 .…”

Section: Introductionmentioning

confidence: 97%

“…11 Although the study did not look at the impact of socioeconomic status, physicians may be partially shielded from the influence of economic factors due to their higher-than-average lifetime earnings. 12 However, this is not universally true for those within other well-compensated professions, and financial considerations were found to be secondary to other motivating factors. 8,11,[13][14][15] Thus, economic factors alone likely do not explain the poor representation of physicians within donor pools.…”

mentioning

confidence: 99%

Fewer medical students are open to body donation after dissecting human cadavers

Gebert

Zhang

2022

Medical Education

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Introduction: Cadaver dissection has long been hailed as a vital component of medical education. Although most physicians acknowledge positive impacts of cadaver dissection on their learning, they are less likely to will their bodies for anatomical dissection than the general public. This study aims to determine whether the proportion of medical students open to willed body donation changes after completing cadaver dissection. Methods:We conducted a longitudinal study surveying 323 medical students across three cohorts before and after anatomical dissection of human cadavers. Through the survey, students indicated whether they would will their body for anatomical dissection. Additionally, students responded to items regarding the rationale underlying their decision, demographics and perceived effects of anatomical dissection on medical education. Results:The proportion of students who expressed openness to willed body donation decreased by 25% after cadaver dissection. Of the 171 students who initially stated they would will their body, 61 (35%) changed their response after completing cadaver dissection. Those who cited religion as a motivating factor were less likely to show openness to body donation, whereas those who cited ethical factors were more likely.Conclusions: This study documents a substantial decrease in the proportion of students open to willed body donation after completion of cadaver dissection. Despite this, students almost universally report educational benefits of cadaver dissection. This raises interesting questions regarding the emotional impact of cadaver dissection and the ethical implications of willed body donation. | INTRODUCTIONAnatomical dissection of human cadavers has long been considered a rite of passage in medical education. 1 Prior to the SARS-CoV-2 pandemic, around 90% of US medical schools still incorporated cadaver labs into their anatomy curriculum. 2 Although the pandemic spurred a shift toward virtual learning, the majority of medical schools still offer in-person labs for first-year students. 2 Many studies have documented a positive impact of cadaver dissection on student learning. [3][4][5] Likewise, the majority of physicians, particularly those in surgical specialties, look favourably on their experiences with cadaver dissection. 5,6 Despite this, a disproportionately small number of physicians donate their bodies to medical school Willed Body Programs. [7][8][9] The discordance between the proportion of physicians who claim to have benefited from cadaver dissection and the proportion willing to donate their own body for medical education remains poorly explained. It is reasonable to posit that physicians, having directly experienced the positive impact of cadaver dissection on their

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Trends in Compensation for Primary Care and Specialist Physicians After Implementation of the Affordable Care Act

Cited by 11 publications

References 3 publications

US Primary Care vs Specialty Care Trainee Positions and Physician Incomes: Trends From 2001 to 2019

US Primary Care vs Specialty Care Trainee Positions and Physician Incomes: Trends From 2001 to 2019

The Trilogy of Health Care: Caring and Healing of the Clinician

Fewer medical students are open to body donation after dissecting human cadavers

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