The Cost Depends on the Value

(Initially published April 27, 2012 on the OccupyHealthcare blog.)

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Last week, Medscape released the results of their 2011 survey of physician compensation:


 I share this post here to point out the discrepancy in physicians' average salaries based on their specialties. In particular, I would like to highlight that the three lowest-paid specialties are the three primary care specialties: pediatrics, family medicine, and general internal medicine.

This post is not written to argue that physicians must be paid more. I would submit that if physicians cannot live on $150,000 then we might be doing something wrong...and we are unlikely to get much sympathy from the average person.

Rather, my intent is to note how undervalued primary care services are in our current system of healthcare delivery and payment. Primary care physicians--the physicians who provide comprehensive care, who provide preventive care, who coordinate care--are paid less than all other medical specialists. Radiology and anesthesiology make nearly twice what primary care doctors do; dermatology and anesthesiology make nearly 175% of the average primary care physician.

This is not to say that these medical specialists do not have important roles in providing medical care; however, should a physician who views x-rays and imaging studies be valued at twice the level of the physicians who keep our children well, who monitor their development and intervene if necessary, and who ensure children are fully vaccinated? Should a physician who deals with skin problems be paid at nearly twice the level of a physician who can deal with many of the same skin problems...while also addressing patients' diabetes, blood pressure, heart disease, and mental illness?

The cost of any given service or item depends on its value. Precious metals are expensive because we value them greatly. Luxury cars are expensive because they are highly valued in our culture. Primary care physicians in the US are paid less than all other specialists, and cost less per physician than all other specialists...indicating that the primary care specialties are valued less than other medical specialties.

We have previously noted the importance of primary care to a high-functioning, efficient, and effective healthcare system. Despite the key role primary care should be playing, however, the chart above shows that primary care is not valued at a commensurate level.

Unless we value primary care, and redesign our healthcare delivery and payment systems to reflect this, then we will continue to have a healthcare system that under-performs even as healthcare costs continue to increase. The cost depends on the value: so long as we do not value primary care, then costs will rise even as outcomes do not improve.

This situation is untenable, and must change. We must demand a healthcare system that values those services and specialties that reduce costs. We must enhance primary care's role in our system in order to improve our system's performance. If we change what type of medical care our system values, then we can truly affect cost.