SACRAMENTO A national study has found that earnings over the course of the careers of primary-care physicians averaged as much as $2.8 million less than the earnings of their specialist colleagues, potentially making primary care a less attractive choice for medical school graduates and exacerbating the already significant shortage of medical generalists.

The results, published online in the journal Medical Care, lead the study's authors to recommend reducing disparities in physician pay to ensure adequate access to primary care, which has been shown to improve health and reduce health-care costs.

"The need for primary-care providers is greater than ever before and expected to grow as millions more Americans become insured under the Affordable Care Act," said J. Paul Leigh, lead author of the study, professor of public health sciences and researcher with the UC Davis Center for Healthcare Policy and Research. "Without a better payment structure, there will be extraordinary demands on an already scarce resource."

According to projections by the Association of American Medical Colleges, the nation is likely to face a shortage of more than 65,000 primary-care physicians by 2025.

For the nationwide study, a follow-up to 2010 research by Leigh and his colleagues on differences in annual wages by specialty, the investigators compared lifetime earnings to demonstrate how annual wage differences accumulate over physicians' careers. The earnings data came from the 2004-05 Community Tracking Study, a periodic evaluation of physician demographic, geographic and market trends.

To ensure valid comparisons, the data were adjusted to account for factors that affect earnings, including age, sex, race, board certification, graduation from a foreign medical school, rural residence, employment by an academic medical school and residency program length.

Incomes were then evaluated for more than 6,000 doctors practicing in 41 specialties. When merged into four broad career categories, lifetime earnings in surgery, internal medicine and pediatric subspecialties, and all other medical specialties averaged from $761,402 to $1,587,722 higher than in primary care:

The earnings differences were more dramatic when compared as 41 separate specialties. Medical oncologists, for instance, earn up to $7,127,543 during a 35-year career, while family medicine practitioners earn as low as $2,838,637.

Leigh surmised that one reason for the earnings differences is the tendency for Medicare administrators to utilize recommendations from an American Medical Association committee on physician pay that price specialist procedures far higher than primary-care office visits. Private insurance companies, in turn, tend to adopt Medicare pay rates.

The authors noted that efforts are under way to resolve physician pay differences. For example, the Affordable Care Act requires states to pay primary-care physicians no less than 100 percent of Medicare payment rates for primary-care services provided to Medicaid patients. The study's senior author, Richard Kravitz, a UC Davis professor of internal medicine, also serves on an independent commission to assess physician pay.

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Large differences in lifetime physician earnings

The Alpert Medical School welcomed its largest class ever this year totalling 120 students following the opening of the schools downtown facility last fall. With the building constructed in downtown Providences Knowledge District able to accommodate more students, the school matriculated 11 additional students in this years class, up from 109 in the class of 2015. The school has expanded from 310 students in 2001 to 421 students this year, according to Ed Wing, dean of medicine and biological sciences.

The admittance of the Med Schools largest-ever class was made possible by the new facility, Wing said. Admitting classes of 120 will expand the school to 480 students in the next few years, he said.

Its a terrific building, Wing said, adding that the schools old space in the BioMedical Center did not allow for expansion. Everything in the (new) building has allowed us to provide better education.

The Med School also witnessed a surge in applications for spots in the class of 2016, with a roughly 20 percent increase from 2,825 applicants in 2011 to 3,344 applications in 2012, according to Philip Gruppuso, associate dean of medical education and professor of pediatrics.

There is in general a physician shortage in the United States, Gruppuso said. He noted that the Association of American Medical Colleges has called for a substantial increase in the countrys supply of doctors and that the University is hoping to aid this goal. Gruppuso said the Med Schools expansion was part of a long-term process that occurred after administrators received permission from the Liaison Committee on Medical Education, the national accrediting organization for medical degree programs.

Wing said administrators have nothing definite planned to expand the student body any further than 480 students.

The Med School hired more staff to accommodate the larger building, but they did not need to hire more faculty members, Wing said, adding that the school boasts a total of 2,000 faculty members, including 600 full-time clinical faculty. The Med School revamped its curriculum but did not add additional classes or expand the size of courses.

Gruppuso said the University is still considered a small medical school according to national rankings of medical degree programs by size.

We had space and resources and faculty to be able to meet the needs of this number of students, he said. We were very confident this (expansion) was not going to result in any kind of erosion of the quality of the medical program.

As part of its expansion, the Med School introduced a new academy model of advising and training last year, with each class divided into three academies of around 40 students in order to facilitate greater advising services and a better sense of community. Each academy space provides locker and study space, designated advisers and other training services to students to help break down the student body into smaller sections.

Excerpt from:
Med school admits largest class ever

The Alpert Medical School welcomed its largest class ever this year totalling 120 students following the opening of the schools downtown facility last fall. With the building constructed in downtown Providences Knowledge District able to accommodate more students, the school matriculated 11 additional students in this years class, up from 109 in the class of 2015. The school has expanded from 310 students in 2001 to 421 students this year, according to Ed Wing, dean of medicine and biological sciences.

The admittance of the Med Schools largest-ever class was made possible by the new facility, Wing said. Admitting classes of 120 will expand the school to 480 students in the next few years, he said.

Its a terrific building, Wing said, adding that the schools old space in the BioMedical Center did not allow for expansion. Everything in the (new) building has allowed us to provide better education.

The Med School also witnessed a surge in applications for spots in the class of 2016, with a roughly 20 percent increase from 2,825 applicants in 2011 to 3,344 applications in 2012, according to Philip Gruppuso, associate dean of medical education and professor of pediatrics.

There is in general a physician shortage in the United States, Gruppuso said. He noted that the Association of American Medical Colleges has called for a substantial increase in the countrys supply of doctors and that the University is hoping to aid this goal. Gruppuso said the Med Schools expansion was part of a long-term process that occurred after administrators received permission from the Liaison Committee on Medical Education, the national accrediting organization for medical degree programs.

Wing said administrators have nothing definite planned to expand the student body any further than 480 students.

The Med School hired more staff to accommodate the larger building, but they did not need to hire more faculty members, Wing said, adding that the school boasts a total of 2,000 faculty members, including 600 full-time clinical faculty. The Med School revamped its curriculum but did not add additional classes or expand the size of courses.

Gruppuso said the University is still considered a small medical school according to national rankings of medical degree programs by size.

We had space and resources and faculty to be able to meet the needs of this number of students, he said. We were very confident this (expansion) was not going to result in any kind of erosion of the quality of the medical program.

As part of its expansion, the Med School introduced a new academy model of advising and training last year, with each class divided into three academies of around 40 students in order to facilitate greater advising services and a better sense of community. Each academy space provides locker and study space, designated advisers and other training services to students to help break down the student body into smaller sections.

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Med School admits largest class yet

The Alpert Medical School welcomed its largest class ever this year totalling 120 students following the opening of the schools downtown facility last fall. With the building constructed in downtown Providences Knowledge District able to accommodate more students, the school matriculated 11 additional students in this years class, up from 109 in the class of 2015. The school has expanded from 310 students in 2001 to 421 students this year, according to Ed Wing, dean of medicine and biological sciences.

The admittance of the Med Schools largest-ever class was made possible by the new facility, Wing said. Admitting classes of 120 will expand the school to 480 students in the next few years, he said.

Its a terrific building, Wing said, adding that the schools old space in the BioMedical Center did not allow for expansion. Everything in the (new) building has allowed us to provide better education.

The Med School also witnessed a surge in applications for spots in the class of 2016, with a roughly 20 percent increase from 2,825 applicants in 2011 to 3,344 applications in 2012, according to Philip Gruppuso, associate dean of medical education and professor of pediatrics.

There is in general a physician shortage in the United States, Gruppuso said. He noted that the Association of American Medical Colleges has called for a substantial increase in the countrys supply of doctors and that the University is hoping to aid this goal. Gruppuso said the Med Schools expansion was part of a long-term process that occurred after administrators received permission from the Liaison Committee on Medical Education, the national accrediting organization for medical degree programs.

Wing said administrators have nothing definite planned to expand the student body any further than 480 students.

The Med School hired more staff to accommodate the larger building, but they did not need to hire more faculty members, Wing said, adding that the school boasts a total of 2,000 faculty members, including 600 full-time clinical faculty. The Med School revamped its curriculum but did not add additional classes or expand the size of courses.

Gruppuso said the University is still considered a small medical school according to national rankings of medical degree programs by size.

We had space and resources and faculty to be able to meet the needs of this number of students, he said. We were very confident this (expansion) was not going to result in any kind of erosion of the quality of the medical program.

As part of its expansion, the Med School introduced a new academy model of advising and training last year, with each class divided into three academies of around 40 students in order to facilitate greater advising services and a better sense of community. Each academy space provides locker and study space, designated advisers and other training services to students to help break down the student body into smaller sections.

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Med school admits largest class ever