I'm only posting this for the benefit of preclinicals interested in family medicine but who feel discouraged by people who might not know what they're talking about.
Realistically,
@username456789 and company, I'm not going to change your mind, I'm not interested in changing your mind, and you've repeatedly turned this into a personally derogatory discussion, when it didn't need to be. I could cite my own experiences directly working on physician compensation, as I've done in the past and provided advice to several attendings via PM, but obviously that's not going to get me very far. So,
@Yadster101:
1.
Consider, from first principles, that following
reasons that may explain why primary care compensation has increased. For example, the Affordable Care Act, as per the RAND Corporation, has expanded insurance coverage
to over 17 million people who previously didn't qualify for insurance. These people are strongly incentivised through the ACA to receive care through primary care specialists, with much higher out-of-pocket costs for ED visits, free annual physicals, and free access to USPTF Grade A or B recommended screenings. Kaiser Permanente, a very large ACO, has publically stated that they could hire
every single medical school graduate in California as primary care specialists and still
not meet demand for their services. That's one of the reasons why they're
starting their own medical school and several new residencies. That's also why everybody is
resorting to midlevels to outsource
easily protocolised care, which most physicians aren't interested in providing anyways. And then there's the reality of an aging population with
multiple medical-comorbidities that make managing these patients
very difficult. Demand, as always, drives compensation.
Yeah, well, you know, that's just, like, your opinion, man. Fine, whatever.
2.
Read the anecdotes of your seniors and colleagues here on SDN. These are folks who are reporting a significant rise in compensation
from their personal experience as FM attendings. Here is one example, and there are more if you search SDN or even reach out to attendings via PM:
http://forums.studentdoctor.net/threads/family-medicine-salaries-continue-to-climb.1206496/.
@Blue Dog is a great, fair-minded attending to follow on the FM subforum.
Well that's just anec-data. Sure.
3.
Look at the large amount of survey data that says compensation in family medicine is
rising much faster than inflation. For example, in 2014, average compensation for primary care specialists grew about 10% between 2014 and 2015, which was the fifth highest rate of increase for any specialty. The CPI for that year was around 1-2%, so compensation grew at about 10 x inflation. This is according to the
Medscape Compensation Survey. You'll say, that's just self-reported nonsense. But it's in concordance with more rigorous surveys of physician compensation like the
MGMA's Physician Compensation and Productivity Survey Report, which you can get through your medical school. These are proprietary data that many practices use as an industry benchmark. In its latest report for 2016, they write that "primary care physicians gained a median 3.6 percent in compensation from the previous year; by comparison, the median compensation for specialists rose 2.4." Merritt Hawkins provides similar data, and just read
their survey of Final Year Family Medicine Residents, which notes that about half of FM residents are contacted
over 100 times by recruiters with job offers in their final year in residency. Finally, according to
Medscape, family medicine ranks sixth among specialties in employing the highest percentage of female physicians, at 35 percent, but male physicians earn, on average, $55,500 more than female physicians--so that skews the data. (There's also
geographic variation, which is a whole other can of worms.)
On a broader note, why is reporting physician compensation so damn difficult? Because
doctors don't get salaried: they get a
mix of salary, remuneration, bonuses and other benefits. For example, in large ACOs, it's roughly 50:45:5 in terms of salary, productivity (remuneration), and other things.
But this ratio varies dramatically outside the ACOs, in more traditionally remunerative private practices, medical groups, Federally Qualified Health Centers, etc. All of these can vary further in terms of Medicare and private insurance payer mix. And then you get into cash only, DPC, concierge models, etc. with make up to about 10% of all FM practices.
How does remuneration work? Ahhh... the RVU. Often misunderstood by residents and even some attendings. I don't want to explain it here. It's
complicated, but I've linked some helpful resources below. Why am I mentioning RVU? Because there's
increasing political pressure to raise RVUs associated with non-procedural specialities, like FM. (As an aside, many FM specialists don't code properly,
and they can easily increase their remuneration by correctly documenting for 99214s, for example).
This topic has been eloquently discussed in the Psychiatry subforum.
Look, it's not all puppies and sunshine. Family Medicine is still one of the lowest compensated specialities with tremendous burnout and lower job satisfaction. (Part of that might have to with its status as the residency of last resort for some medical students, who probably weren't keen on family medicine in the first place, but that's my controversial opinion.)
But the speciality offers a lot of advantageous. It's tremendously flexible; you can work all around the world with
reciprocal licensing agreements in Canada, Australia, New Zealand; and, most definitely,
compensation is rising.
Fear of midlevels is largely a bogeyman. It certainly hasn't resulted in a net negative impact on compensation in family medicine.
And the game is played way the hell above our heads anyways. You're not going to get far arguing about it on SDN or mentioning it to your clerkship director, especially when if it means insulting or alienating people.
Preclinicals, I wish you the best of luck. Like I said before, I think the most important skill to develop is the ability to
critically evaluate knowledge. You don't know me, and you don't know my qualifications. All you know is the data I've presented. Make up your own minds, and don't rule out a specialty (or needlessly denigrate your colleagues or other health professionals) based on the advice of your sometimes uninformed seniors.
http://medgroup.ucsf.edu/sites/medgroup.ucsf.edu/files/the_basics_of_rvus_and_rbrvs_0.pdf
https://www.sgim.org/File Library/SGIM/Communities/Advocacy/Advocacy 101/Do-RVUs-Undervalue-Primary-Care---Primer-on-the-RUC-3-14-2014.pdf
