A difference of $3.5 million

There's a great story on Bloomberg Businessweek titled, "For Health Care to Work, These Doctors Need a Big Raise." It starts with this:

Specialists earn $3.5 million more, on average, than general practitioners over the course of a career. A federal panel wants to reduce the discrepancy.

In this story, James Warren writes how a family physician or general internist averages about $160,000 a year, according to the nonprofit Robert Graham Center. A specialist averages $267,000 (seems low to me). That means the generalist will earn about $3.5 million less over a lifetime.

If we do the math (sorry, I can't help it because I went to MIT), we'll see that the difference is $107,000 per year. If we continue to work backwards, we see that to get $3.5 million, the average doctor is working approximately 32.7 years in his or her career. Does that seem right? We must remember that a generalist has a 3-year residency whereas most specialists have a longer residency (anywhere from 3 to 10+ years if we're including fellowships). So, is this calculation accurate?

Regardless, I think we all get the picture. The reality is that many primary care physicians aren't even making anything close to $160,000. In fact, they're struggling to survive because reimbursement is low and slow.  If you add the fact that many PCPs are not satisfied with their work, then we should not be surprised to find that many PCPs are choosing to leave clinical medicine to pursue other endeavors. 

In the future, maybe all physicians will be salaried by the hospital. In the future, maybe primary care will be provided by NPs and PAs.