Why are primary care physicians paid significantly less than specialists?

[JCstiggy]

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Why are primary care physicians paid significantly less than specialists?

Certainly this is not a simple question to answer, but I'm curious. I will begin medical school this fall and primary care is what I am most interested in pursuing. Salary is not a big factor in my decision, but I would like to know why I will potentially be paid less than doctors in other fields.

 

[Slowpoke]

Perhaps it is because of supply and demand? Many more family medicine physicians than there are neurosurgeons? Some of the top earning specialties also are able to perform expensive elective procedures that rake in the dough.

 

[JP2740]

Someone once decided that procedures get more money than talking to a patient. It's more complicated than that and I probably just made an ass out of myself. I'll go study now

 

[Frazier]

...Because the government said so.

Cash-based, freestanding practices aside, reimbursement from insurance is often trailing the path that the government sets for reimbursement.

The government likes to cut the lowest hanging fruit first (ie as procedures become more efficient, they get chopped [think cataract surgery]...likewise, as procedures are noticed for being extremely profitable, they get chopped [think spine surgery no longer being allowed to bill by vertebrae]).

However, even with greatly reduced reimbursements, specialists have maintained nice salaries. Sometimes by being more entrepreneurial than decades ago (think derms hiring NP's to increase volume) or by adopting a worse lifestyle (think rads working at "sweatshop"-like pacing).

Primary care, without billing for their own labs/etc, has a bottleneck in their earning potential since they aren't as procedure-based as specialists. They have to communicate with the patient more and communication doesn't earn the big $$$.

The government has implied that they intend on shifting the income disparity between primary and specialist care. Will it be true?

Well....

 

[RIPSanto]

Because most of the time specialists go through additional years of training, work more hours, take more call on holidays/in the middle of the night etc... It would be hard to have an adequate supply of neurosurgeons if they made 150K.

 

[Frazier]

Because most of the time specialists go through additional years of training, work more hours, take more call on holidays/in the middle of the night etc... It would be hard to have an adequate supply of neurosurgeons if they made 150K.

I agree with the conclusion.

Sometimes people try to explain the differences in reimbursement by reasoning "well, the specialist goes through X more years of residency and then Y more years in fellowship than your typical PCP. All that extra training warrants a higher income!"

Problem is that in reality no one gives a damn whatsoever how much longer you trained or how you "gave up your twenties" or any of the other touchy-feely, individual-centered considerations. Only the physician themselves have those thoughts.

The reason neurosurgeons don't make 150k is like the guy said above...basically no one would want to do it. Government/society doesn't want that to occur, so they accommodate accordingly.

"Ahh, but Jimmy the surgeon spent all those extra years in that terrible QoL residency. He really should be treated well for his hard work!" -- said no politician, medicare/insurance quant, or CEO ever.

 

[BuddyTheElf]

Someone once decided that procedures get more money than talking to a patient. It's more complicated than that and I probably just made an ass out of myself. I'll go study now

👍

 

[Pons Asinorum]

Why are primary care physicians paid significantly less than specialists?

Certainly this is not a simple question to answer, but I'm curious. I will begin medical school this fall and primary care is what I am most interested in pursuing. Salary is not a big factor in my decision, but I would like to know why I will potentially be paid less than doctors in other fields.

Interesting that you thought an anonymous bunch of online medical students a more reliable source to answer this question than any of the things that would have shown up in a google search, such as the last 50 things someone like Ezekiel Emanuel or Atul Gawande have written.

 

[yoyostring]

Perhaps it is because of supply and demand? Many more family medicine physicians than there are neurosurgeons? Some of the top earning specialties also are able to perform expensive elective procedures that rake in the dough.

Supply and demand?

Family med is low paid, but also has one of the highest demands as there is a significant shortage.

 

[Pons Asinorum]

Supply and demand?

Family med is low paid, but also has one of the highest demands as there is a significant shortage.

By demand, you mean what? Are there bidding wars for newly minted BC/CE FM physicians? FM is poorly reimbursed, and that's why they don't fill seats with AMG grads with great stats. From the way you phrase your post, it looks like you're putting the cart before the horse with your understanding of markets.

 

[IlDestriero]

High risk high reward.

 

[cubssox2000]

Someone once decided that procedures get more money than talking to a patient. It's more complicated than that and I probably just made an ass out of myself. I'll go study now

This. You can charge (and get paid) for doing, not for thinking. Specialists do, primary physicians think.

 

[Gut Shot]

Why are primary care physicians paid significantly less than specialists?

Certainly this is not a simple question to answer, but I'm curious. I will begin medical school this fall and primary care is what I am most interested in pursuing. Salary is not a big factor in my decision, but I would like to know why I will potentially be paid less than doctors in other fields.

http://economix.blogs.nytimes.com/2...-decision-makers-for-medicare-physicans-fees/

The Medicare fee schedule drives all the fee schedules for the private insurers. Back in the 80's Medicare was looking for a way to move away from paying UCR (usual, customary, reasonable) rates to physicians, and they did that by establishing the RVU (relative value unit). A given service would reflect a certain number of RVUs, which would then be plugged into a formula to determine the amount paid.

So who determines how many RVUs are attached to various services? To do this Medicare relies on the RUC, an AMA subcommittee composed of 29 physicians who are mostly specialists. It is apparently the RUC that has been driving the widening gap in reimbursement for the past 15+ years.

So there you go.

 

[Pons Asinorum]

http://economix.blogs.nytimes.com/2...-decision-makers-for-medicare-physicans-fees/

The Medicare fee schedule drives all the fee schedules for the private insurers. Back in the 80's Medicare was looking for a way to move away from paying UCR (usual, customary, reasonable) rates to physicians, and they did that by establishing the RVU (relative value unit). A given service would reflect a certain number of RVUs, which would then be plugged into a formula to determine the amount paid.

So who determines how many RVUs are attached to various services? To do this Medicare relies on the RUC, an AMA subcommittee composed of 29 physicians who are mostly specialists. It is apparently the RUC that has been driving the widening gap in reimbursement for the past 15+ years.

So there you go.

And.../thread.

 

[sinombre]

http://economix.blogs.nytimes.com/2...-decision-makers-for-medicare-physicans-fees/

The Medicare fee schedule drives all the fee schedules for the private insurers. Back in the 80's Medicare was looking for a way to move away from paying UCR (usual, customary, reasonable) rates to physicians, and they did that by establishing the RVU (relative value unit). A given service would reflect a certain number of RVUs, which would then be plugged into a formula to determine the amount paid.

So who determines how many RVUs are attached to various services? To do this Medicare relies on the RUC, an AMA subcommittee composed of 29 physicians who are mostly specialists. It is apparently the RUC that has been driving the widening gap in reimbursement for the past 15+ years.

So there you go.

Wow, I didn't know that. Here's a list of the specialty composition of the RUC for anyone interested:

http://www.ama-assn.org/ama/pub/phy...ive-value-scale/the-rvs-update-committee.page

 

[RIPSanto]

I still think it has to do with lifestyle and length of training. Does it not make sense that extra years of training and a terrible lifestyle should pay more than a 3 year residency and M-F 8am-5pm with Thursday afternoons off for a round of 18 on mens day? Obviously, this is a drastic over simplification (derm is best of both worlds).

I mean, after all, primary care can be pretty lucrative in the right setting. If you are willing to see patients starting at 7 am, not go home until after 6 pm and come in for half a day on saturday's you will probably make as much money as some of your specialist colleagues

 

[VenusinFurs]

I still think it has to do with lifestyle and length of training. Does it not make sense that extra years of training and a terrible lifestyle should pay more than a 3 year residency and M-F 8am-5pm with Thursday afternoons off for a round of 18 on mens day? Obviously, this is a drastic over simplification (derm is best of both worlds).

I mean, after all, primary care can be pretty lucrative in the right setting. If you are willing to see patients starting at 7 am, not go home until after 6 pm and come in for half a day on saturday's you will probably make as much money as some of your specialist colleagues

I don't think there's too many PCPs out there who just do 8-5 M-F anymore.

 

[thefritz]

Salary is not a big factor in my decision, but I would like to know why I will potentially be paid less than doctors in other fields.

That's good, because during your career you most likely won't be paid a 'salary,' which is something most med students fail to grasp, even at graduation.

 

[thefritz]

I don't think there's too many PCPs out there who just do 8-5 M-F anymore.

If anything, more are now. Previously being a PCP was a 24/7 job and lifestyle. Midlevels, larger practice groups, and hospitalists these days are at least presenting an option for docs who don't want to run a solo practice and round on their patients in the hospital every morning.

 

[Textbookversion]

http://economix.blogs.nytimes.com/2...-decision-makers-for-medicare-physicans-fees/

The Medicare fee schedule drives all the fee schedules for the private insurers. Back in the 80's Medicare was looking for a way to move away from paying UCR (usual, customary, reasonable) rates to physicians, and they did that by establishing the RVU (relative value unit). A given service would reflect a certain number of RVUs, which would then be plugged into a formula to determine the amount paid.

So who determines how many RVUs are attached to various services? To do this Medicare relies on the RUC, an AMA subcommittee composed of 29 physicians who are mostly specialists. It is apparently the RUC that has been driving the widening gap in reimbursement for the past 15+ years.

So there you go.

This. Has very little to do with supply and demand. Glad someone typed up the real answer I was too lazy to do so.

 

[D elegans]

Wow, I didn't know that. Here's a list of the specialty composition of the RUC for anyone interested:

http://www.ama-assn.org/ama/pub/phy...ive-value-scale/the-rvs-update-committee.page

Primary care only gets a "rotating seat" Guess that explains a lot

 

[SpecterGT260]

Supply and demand?

Family med is low paid, but also has one of the highest demands as there is a significant shortage.

This is correct, but only so long as I am correct in assuming that your second statement is a counterpoint to the one you quoted.

By demand, you mean what? Are there bidding wars for newly minted BC/CE FM physicians? FM is poorly reimbursed, and that's why they don't fill seats with AMG grads with great stats. From the way you phrase your post, it looks like you're putting the cart before the horse with your understanding of markets.

You missed the context. The guy he quoted gave the "supply and demand" argument. FM is in some of the highest demand right now by the "clientele", but supply and demand do not fix prices in medicine. The guy you quoted was, in effect, saying exactly that (i.e. that supply and demand do not apply because you get the opposite of what you would expect).

 

[SpecterGT260]

I agree with the conclusion.

Sometimes people try to explain the differences in reimbursement by reasoning "well, the specialist goes through X more years of residency and then Y more years in fellowship than your typical PCP. All that extra training warrants a higher income!"

Problem is that in reality no one gives a damn whatsoever how much longer you trained or how you "gave up your twenties" or any of the other touchy-feely, individual-centered considerations. Only the physician themselves have those thoughts.

The reason neurosurgeons don't make 150k is like the guy said above...basically no one would want to do it. Government/society doesn't want that to occur, so they accommodate accordingly.

"Ahh, but Jimmy the surgeon spent all those extra years in that terrible QoL residency. He really should be treated well for his hard work!" -- said no politician, medicare/insurance quant, or CEO ever.

I had a rather long and mathy post in another thread about this awhile back where I showed that if you substantially increase PCP reimbursement and physicians flow into primary care to follow, the total money pool for reimbursement can stay steady (or may even be allowed to shrink) without affecting specialist salaries at all. The math works out just fine. There is such a disparity between specialist averages and PCP averages that your average specialist moving to primary care could nearly fund 2 PCPs. Basically, if they "leave" a specialty and therefore take their slice of the reimbursement pie with them, everyone in primary care benefits.

The only remaining question is "how many specialists do we need". And this number will fall drastically if we enforced routes of referral rather than allowing said neurosurgeons to see people with a Hx of 48 hours of LBP for surgical consult. (p.s. this happens, and is overwhelmingly common, even approaching the norm nowadays)

 

[Pons Asinorum]

You missed the context. The guy he quoted gave the "supply and demand" argument. FM is in some of the highest demand right now by the "clientele", but supply and demand do not fix prices in medicine. The guy you quoted was, in effect, saying exactly that (i.e. that supply and demand do not apply because you get the opposite of what you would expect).

I guess I would argue that FM is not in the highest demand right now, especially not by the "clientele." I don't see the current state of FM pay and residency competitiveness as a failure of "supply and demand" but rather as data point in our broader health care market. You can't argue that you wish to subtract the capitalism, as some here are, from health care and simultaneously argue that FM isn't currently a part of the capitalist health care system and removed from the market forces that have shaped what we have. If we had a more capitalist health care system, the disequilibrium that you see in FM would be corrected by market forces, i.e. more reimbursement for the job which would make it a more competitive residency match. That's not happening because of non-capitalist distortions in the market. See prior RUC discussion.

 

[IlDestriero]

The good neurosurgeons in my area have zero interest in seeing this kind of consult. They'll see you after your PCP orders and you receive an MRI and there is an issue that might be surgical. If they don't think that they can operate, or there are no acute deficits, they're not giving you a consult/appointment. They make money operating, not trolling the ED for potential procedures.

 

[rocketbooster]

Primary care only gets a "rotating seat" Guess that explains a lot

LOL what a scam. Oh well not my problem.

 

[SpecterGT260]

I guess I would argue that FM is not in the highest demand right now, especially not by the "clientele." I don't see the current state of FM pay and residency competitiveness as a failure of "supply and demand" but rather as data point in our broader health care market. You can't argue that you wish to subtract the capitalism, as some here are, from health care and simultaneously argue that FM isn't currently a part of the capitalist health care system and removed from the market forces that have shaped what we have. If we had a more capitalist health care system, the disequilibrium that you see in FM would be corrected by market forces, i.e. more reimbursement for the job which would make it a more competitive residency match. That's not happening because of non-capitalist distortions in the market. See prior RUC discussion.

You missed it again The last part I underlined here was actually in the thing you quoted from me..... "Supply and demand do not fix prices in medicine".

Poster 1: "Supply and demand! "
The guy you quoted: "Supply and demand? But they are in demand and are not payed well..."
You: "how is that supply and demand then?"
Me: "because it isnt....."
You: "then tell me how it is... I don't think it is..."
Me: (this post) 😕 wtf......

You can say they aren't in demand.... maybe that is debatable. The "physician shortage" certainly isn't complaining about a lack of specialists, however. The point here is that myself and the person you quoted were saying the opposite of what you keep suggesting we are saying in your counterpoints. If you are still not clear on what I am saying, see my previous post here as well.

 

[RIPSanto]

I had a rather long and mathy post in another thread about this awhile back where I showed that if you substantially increase PCP reimbursement and physicians flow into primary care to follow, the total money pool for reimbursement can stay steady (or may even be allowed to shrink) without affecting specialist salaries at all. The math works out just fine. There is such a disparity between specialist averages and PCP averages that your average specialist moving to primary care could nearly fund 2 PCPs. Basically, if they "leave" a specialty and therefore take their slice of the reimbursement pie with them, everyone in primary care benefits.

The only remaining question is "how many specialists do we need". And this number will fall drastically if we enforced routes of referral rather than allowing said neurosurgeons to see people with a Hx of 48 hours of LBP for surgical consult. (p.s. this happens, and is overwhelmingly common, even approaching the norm nowadays)

Thats all fine and dandy, but it still has to do with hours, lifestyle and training...

40 hours/week and 150K, or 80 hours/week and 300K.... aren't they paid equally?

 

[calvnandhobbs68]

Thats all fine and dandy, but it still has to do with hours, lifestyle and training...

40 hours/week and 150K, or 80 hours/week and 300K.... aren't they paid equally?

Nobody is working 80 hours a week for only 300K. That's working every day of the week 11.5 hours a day. I think people underestimate how long 80 hours a week is then go around spouting all the time that surgeons work 80 hours a week.

FP docs don't work only 40 hours a week either. The actual average is closer to 50 hours a week.

Edit: I shouldn't necessarily say "only 300K" because I'm sure there are general surgeons who have to work that much for that kind of money. However, your typical anesthesiologist, derm, ortho, etc. is not working 80 hours a week for their 300K

 

[SpecterGT260]

Thats all fine and dandy, but it still has to do with hours, lifestyle and training...

40 hours/week and 150K, or 80 hours/week and 300K.... aren't they paid equally?

Why do you give a damn what someone else with a different job (regardless of shared territory on a venn diagram) gets paid per hour? When you take a job, you sign a contract for work provided for compensation and that has nothing to do with what the next guy agrees to do work for. To be completely honest, work of all types is optional (and there is a dude at the end of my street with a cardboard sign that proves it). The issue at hand is a shortage of PCPs, and rising costs for the "consumer" such that they don't want to pay as much. The guy they complain about not having is the one being hurt the most by the "fixes".

I'm not really aware of too many attendings who still work 80 hours a week... that 300k figure for specialists happens at weekly hours pretty comparable to their PCP counterparts. Maybe a little longer hours, but they are also reimbursed at higher rates. Regardless of the facts concerning hours, the issue still boils down to fixing the PCP shortage issue. One side says "pay them more". The other says "but that is paramount to taking money out of the hands of specialists". Turns out, that second argument is only true if you pay PCPs more without moving docs into primary care. That was my point.

 

[SpecterGT260]

Nobody is working 80 hours a week for only 300K. That's working every day of the week 11.5 hours a day. I think people underestimate how long 80 hours a week is then go around spouting all the time that surgeons work 80 hours a week.

FP docs don't work only 40 hours a week either. The actual average is closer to 50 hours a week.

Edit: I shouldn't necessarily say "only 300K" because I'm sure there are general surgeons who have to work that much for that kind of money. However, your typical anesthesiologist, derm, ortho, etc. is not working 80 hours a week for their 300K

Your typical g.surg isn't even pulling those hours regularly..... that is what the residents are for

 

[KinasePro]

Here's one explanation that was interesting to me:

Think about the lowest common denominator in each field, and then consider what their work is "worth." Look at the below-average, underperforming PCP who serves mostly as a gateway to the specialists & antibiotics. This person is very easily replaced by someone of less training and for a lower price, and these types of physicians will admit that to you. A below average PCP can be arguably replaced by a good mid-level.

Now contrast that will a below-average neurosurgeon, who is nevertheless still clipping aneurysms and stabilizing trainwreck spine/head traumas. He /She can be as mediocre as they come, but they're nevertheless directly taking on tremendous risk and definitively changing people's immediate health. Which one's work is intrinsically "worth" more? Who are you more willing to piss off?

It's not like PCP's haven't been lobbying for more $$ for the last 2 decades... they have. But it's easy to marginalize them when the lowest-common denominator can be replaced for less $$.

 

[Armadillos]

Really just comes down the fact the government says primary care should make less by however they set the medicare/medicaid rates which then correlates over to the insurance level.

Those rates value 15 minutes spent sticking needles/devices into people much more highly than spending those same 15 minutes talking or doing a physical exam.

Also, dont let people try to sell you the idea that its based on the length of training, pediatric specialists have 6 yrs of post grad training and make way less than most specialties ranging from 3-5 years of training.

 

[dantt]

Specialists do, primary physicians think.

Sometimes.

 

[JCstiggy]

I guess I would argue that FM is not in the highest demand right now, especially not by the "clientele."

Have you been living under a rock? There is a major doctor shortage in basically every specialty, but primary care is by far the worst. Every PCP I have talked to with their own practice has told me they either cannot take on any new patients or very few due to their workload. Thus a significant number of people struggle to find a new PCP because they are turned away.

We are short roughly 9,000 PCPs in the U.S. right now according to current demand. This is going to get exponentially worse next year when about 30 MILLION Americans gain health insurance through the Affordable Care Act. A small percentage of that 30 million will need a specialist right away, they will all need a PCP. Also, the projected shortage for primary care alone in 2025 is 65,800.

source: https://www.aamc.org/download/158076/data/updated_projections_through_2025.pdf

 

[Pons Asinorum]

Have you been living under a rock? There is a major doctor shortage in basically every specialty, but primary care is by far the worst. Every PCP I have talked to with their own practice has told me they either cannot take on any new patients or very few due to their workload. Thus a significant number of people struggle to find a new PCP because they are turned away.

We are short roughly 9,000 PCPs in the U.S. right now according to current demand. This is going to get exponentially worse next year when about 30 MILLION Americans gain health insurance through the Affordable Care Act. A small percentage of that 30 million will need a specialist right away, they will all need a PCP. Also, the projected shortage for primary care alone in 2025 is 65,800.

source: https://www.aamc.org/download/158076/data/updated_projections_through_2025.pdf

All true, but the specialty seems to be having trouble attracting allopathic seniors. 2708 ACGME spots offered in 2011, filled by 1465 allo seniors, rest by DO, IMG, FMG. 153 spots went unfilled. I'll leave it to someone smarter than I to explain how such an in demand specialty has a hard time filling seats. Seems like jobs post-grad would be abundant and well paying since there is such a shortage.

 

[Pons Asinorum]

And yes, I do live under a rock.

 

[IlDestriero]

All true, but the specialty seems to be having trouble attracting allopathic seniors. 2708 ACGME spots offered in 2011, filled by 1465 allo seniors, rest by DO, IMG, FMG. 153 spots went unfilled. I'll leave it to someone smarter than I to explain how such an in demand specialty has a hard time filling seats. Seems like jobs post-grad would be abundant and well paying since there is such a shortage.

Because clinic sucks and primary care is essentially all clinic.

 

[SpecterGT260]

All true, but the specialty seems to be having trouble attracting allopathic seniors. 2708 ACGME spots offered in 2011, filled by 1465 allo seniors, rest by DO, IMG, FMG. 153 spots went unfilled. I'll leave it to someone smarter than I to explain how such an in demand specialty has a hard time filling seats. Seems like jobs post-grad would be abundant and well paying since there is such a shortage.

How does this impact your statement of them not being "in demand by the clientele" (i.e. the patients).... 😕 I feel like you are yo-yoing hard core in your posts....

 

[rompebielas]

Here's one explanation that was interesting to me:

Think about the lowest common denominator in each field, and then consider what their work is "worth." Look at the below-average, underperforming PCP who serves mostly as a gateway to the specialists & antibiotics. This person is very easily replaced by someone of less training and for a lower price, and these types of physicians will admit that to you. A below average PCP can be arguably replaced by a good mid-level.

Now contrast that will a below-average neurosurgeon, who is nevertheless still clipping aneurysms and stabilizing trainwreck spine/head traumas. He /She can be as mediocre as they come, but they're nevertheless directly taking on tremendous risk and definitively changing people's immediate health. Which one's work is intrinsically "worth" more? Who are you more willing to piss off?

It's not like PCP's haven't been lobbying for more $$ for the last 2 decades... they have. But it's easy to marginalize them when the lowest-common denominator can be replaced for less $$.

This is what I wonder, how long before the NP and PAs will be considered PCPs. I heard that PAs can own their own practices in certain states but don't know the exact details.

 

[SpecterGT260]

This is what I wonder, how long before the NP and PAs will be considered PCPs. I heard that PAs can own their own practices in certain states but don't know the exact details.

A "practice" is just a business. The education one has is of no bearing to whether or not you can "own" the practice. Most people have bosses. If you have the funds to start up the practice, you can hire physicians to work in the practice. If you also happen to be a PA then you are a PA that owns a practice. For example, a good many (if not most.. I just don't wanna look it up right now but I suspect it is nearly all) hospitals are not owned by physicians or people holding MD or DO degrees. Yet these hospitals often own many of the practices within them.

 

[survivordo]

Really just comes down the fact the government says primary care should make less by however they set the medicare/medicaid rates which then correlates over to the insurance level.

Those rates value 15 minutes spent sticking needles/devices into people much more highly than spending those same 15 minutes talking or doing a physical exam.

Also, dont let people try to sell you the idea that its based on the length of training, pediatric specialists have 6 yrs of post grad training and make way less than most specialties ranging from 3-5 years of training.

While I agree it is not all about length of training I would remind everyone that sticking a need/device into someone incurs significantly more risk than talking or doing a physical exam. Someone who is willing to take that risk and has the specialized training to perform it is compensated accordingly.

Survivor DO

 

[45408]

Wow, I didn't know that. Here's a list of the specialty composition of the RUC for anyone interested:

http://www.ama-assn.org/ama/pub/phy...ive-value-scale/the-rvs-update-committee.page

Well, they are mostly evaluating how many RVUs are assigned to procedures, so it kind of makes sense to have all the people who do procedures.

Whether or not we should be using RVUs at all is a different question that wouldn't be answered by this group.

I don't think there's too many PCPs out there who just do 8-5 M-F anymore.

There's probably MORE now than ever. They don't have to admit anyone (the hospitalists do that) or work on the weekends (just go to urgent care), and being "on call" can be shielded by a nurse hotline that tells most patients to go to the ED...

 

[rocketbooster]

Well, they are mostly evaluating how many RVUs are assigned to procedures, so it kind of makes sense to have all the people who do procedures.

Whether or not we should be using RVUs at all is a different question that wouldn't be answered by this group.


There's probably MORE now than ever. They don't have to admit anyone (the hospitalists do that) or work on the weekends (just go to urgent care), and being "on call" can be shielded by a nurse hotline that tells most patients to go to the ED...

This. Family med docs working long hours and hospitalizing their own pts are a dying breed. All the younger ones want 8-5 with a half day off and no hospital call. If I were them I would do the samething haha. Seems like a generational difference across most medicine.

 

[KnuxNole]

Because clinic sucks and primary care is essentially all clinic.

I love clinic 😱

 

[Law2Doc]

Your typical g.surg isn't even pulling those hours regularly..... that is what the residents are for

Um no. The junior attendings in surgery work more hours than the residents. ACGME duty hour caps put ceilings on what residents and fellows can work but as soon as you are an attending those caps are gone. The younger attendings do the lions share of call for their group, and so topping 100 hours a week is not that unusual while "paying your dues" as a junior attending in a group. You will see attendings up all night doing emergency cases and then still have to do a normal work day the next day, while residents aren't allowed to go beyond 28 hours in a row under the current rules.

 

[JCstiggy]

Just so we can give the "number of hours worked" argument some perspective. Take a gander at the following study.

http://archinte.jamanetwork.com/article.aspx?articleid=1105820

To say that specialists are the ones working longer hours and primary care the fewest is completely false. In fact, primary care physicians are on average in the middle of the road when it comes to hours worked, and put in more hours than many other specialties overall.

 

[45408]

Just so we can give the "number of hours worked" argument some perspective. Take a gander at the following study.

http://archinte.jamanetwork.com/article.aspx?articleid=1105820

To say that specialists are the ones working longer hours and primary care the fewest is completely false. In fact, primary care physicians are on average in the middle of the road when it comes to hours worked, and put in more hours than many other specialties overall.

Most people in medicine know that derm and PM&R are on the easy end of the spectrum, and other than optho and plastics, none of the ones below FP are surgeons or even proceduralists. Pediatrics and psychiatry are also in the realm of primary care and were both below FP as well, so you can't say "primary care is in the middle" when hospitalists, psychiatrists, general practitioners, child psychiatrists and pediatricians are all below the FP mark.

 

[JCstiggy]

Most people in medicine know that derm and PM&R are on the easy end of the spectrum, and other than optho and plastics, none of the ones below FP are surgeons or even proceduralists. Pediatrics and psychiatry are also in the realm of primary care and were both below FP as well, so you can't say "primary care is in the middle" when hospitalists, psychiatrists, general practitioners, child psychiatrists and pediatricians are all below the FP mark.

You're forgetting internal medicine, which is pretty much dead in the middle. And I'm not arguing that proceduralists work fewer hours, I know they don't and it is represented in the data.

 

[calvnandhobbs68]

Anyone notice that the neurosurg hours doesn't make any sense...