Tuesday, May 18, 2010

The Grand Game! Physician Salary Edition

Can we play The Grand Game? Can we? This is just a short version, because all we have is the abstract of the paper. (Yes, you are welcome to use a library subscription to get the actual paper. I am sure there are other delights there, also).

But for now....what is the most amazingly nonsensical claim? That's the Grand Game, folks....

Can We Close The Income And Wealth Gap Between Specialists And Primary Care Physicians?

Bryan Vaughn, Steven DeVrieze, Shelby Reed & Kevin Schulman
Health Affairs, May 2010, Pages 933-940

Abstract: Over their lifetimes, primary care physicians earn lower incomes-and accumulate considerably less wealth-than their specialist counterparts. This gap influences medical students, who are choosing careers in primary care in declining numbers. We estimated career wealth accumulation across specialists, primary care physicians, physician assistants, business school graduates, and college graduates. We then compared specialists, represented by cardiologists, to primary care physicians in four scenarios. The wealth gap is substantial; narrowing it would require substantial reductions in specialists' practice income or increases in primary care physicians' practice income, or both, of more than $100,000 a year. Current proposals for increasing primary care physician supply would do little to lessen these differences.

I'll go first!

1. Why would you WANT to have equal salaries across primary care and all specialties? Why in the world would that be any kind of important policy goal, given all the other problems we have in health care?

2. Given that one might one might have such a goal (I don't, but...), why in the name of Hippocrates would you consider reducing the income of specialists? Yes, you might encourage competition, for its many benefits, one of which might be a reduction in monopoly rents for specialists. But just going in and messing with prices, as a stand-alone goal... amazing.

(Nod to Kevin L, for the article)


Unknown said...

The enthusiasm for the Grand Game reminds me of the enthusiasm we used to have when we played Schelling point...Josh P was especially enthused

Bill said...

Egalitarianism gone mad. The authors need to read Kurt Vonnegut's "Harrison Bergeron."

Mungowitz said...

Josh P only had two states:
1. Asleep
2. Especially enthused

Frank said...

Re: "Current proposals for increasing primary care physician supply would do little to lessen these differences."

Some staggeringly bad economics here--if the supply of primary care docs increases, their incomes will decrease thereby increasing the dreaded gap.