FAMILY PHYSICIAN SALARIES UP, BUT STILL TRAIL THOSE OF SUBSPECIALISTS

Need for Value-based Compensation

“The survey demonstrates that the importance of family medicine continues to be undervalued by the health care system,” said AAFP President Robert Wergin, MD, of Milford, Nebraska. “There is hope that with passage of the MACRA (Medicare Access and CHIP [Children’s Health Insurance Program] Reauthorization Act) legislation, there will be a movement away from the volume-based, fee-for-service world that is focused on acute illness and episodic care to a payment system that is value-based, and this will improve the compensation and value of family physicians.”

As it stands, 47% of primary care physicians think they are compensated fairly, compared with 50% of other specialists.

It is worth noting that a physician’s practice situation exerts a significant influence on annual compensation. Primary care physicians who are employed earn an average of $189,000 annually compared with $212,000 for self-employed physicians.

In addition, family medicine ranks sixth among specialties in employing the highest percentage of female physicians, at 35%. Unfortunately, however, the gender-based income gap in medicine continues, with male physicians across all specialties earning, on average, $55,500 more than female physicians.

“There is a disparity in our profession, and as an Academy, we have to keep advocating for equal pay for equal work,” Wergin said. “We’re behind, and not just in family medicine.”

Focus on Other Practice Issues

The survey covered much more than salary issues, also focusing on hours spent with patients and overall career satisfaction. Several questions focused specifically on primary care, including family medicine.

For example, 34% of family physicians said they spend between 13 and 16 minutes with each patient, another 23% reported they spend 17 to 20 minutes per patient, and 22% said they spend 9 to 12 minutes with each patient. Primary care physicians overall devote considerable time to paperwork and administration, with 33% of self-employed and 27% of employed primary care physicians reporting that it takes 10 to 14 hours per week.

Regarding career satisfaction, family physicians ranked highest in terms of saying they would choose a career in medicine again, with 73% reporting that they would. But only 32% of family physicians said they would choose the same specialty.

AAFP President-elect Wanda Filer, MD, MBA, of York, Pennsylvania, said that although she was “thrilled” to see that family physicians were the specialists most likely to say they would choose medicine again, she was concerned that so few of them would again choose family medicine as their specialty. She chalked it up to the stress of navigating an increasingly complex practice environment.

“I know that burnout is a huge issue, brought on, at least in part, by ridiculous administrative burdens that take us away from rewarding face-to-face time with patients—the real reason we went into medicine,” Filer said.

Filer is encouraged to see residents and students “who are ready to change the world,” but cautioned that more needs to be done to ensure that family physicians who have been in practice for a while retain that same enthusiasm.

“It is important to help all of our members rediscover and sustain the joy of practice,” she said. “We work daily to mitigate those many burnout factors coming from the practice front.”

According to the survey report, family physicians ranked eighth overall in terms of offering new ancillary services—such as MRI, physical therapy, orthotics, or in-office surgery—in their practice in the past 3 years, with 23% saying they have offered a new service during that period.

The report also noted that overall physician participation in accountable care organizations (ACOs) continues to grow at a rapid rate, with the percentage increasing from just 3% in 2011 to 30% in the 2015 survey report. Among primary care physicians, 35% said they participated in an ACO.

Wergin remains optimistic that policy changes at the federal level and a shift toward a greater emphasis on primary care worldwide are promising trends.

“Our value is going to increase as it is already recognized in every other developed country in the world,” he said. “Countries such as Canada and England realized you cannot build a health care delivery system without a strong primary care base, and they reimburse their primary care physicians in line with that value.

“We’re behind those systems now, but we’re moving in their direction.”