Matching 25% of Medical Students in Family Medicine by 2030: Realistic or Beyond Our Reach?

ABSTRACT: This article examines the America Needs More Family Doctors: 25x2030 Collaborative goal of “25x30”—that 25% of all medical students will enter family medicine residency programs by the year 2030. Filling 25% of all available postgraduate year-1 positions in the match is an important consideration in creating a strong primary care workforce. Data from the National Resident Matching Program (NRMP) matches for 2010 and 2020 are reviewed to examine trends not only in the US MD and DO categories, but also US international medical school graduates (IMGs) and non-US IMG categories over the last 10 years. If the total number of all programs and of all positions offered were held constant in 2030, what shifts in student choices would be required to reach the 25x30 goal in each applicant category as well as for all four categories combined? This discussion explores resources, power, physician income, and other factors that affect student numbers. Until a national health system is developed with national goals and priorities, it is unlikely that 25x30 will become a reality.

Practice composition and sex differences in physician income: observational study

ObjectiveTo assess whether differences in income between male and female physicians vary according to the sex composition of physician practices.DesignRetrospective observational study.SettingUS national survey of physician salaries, 2014-18.Participants18 802 physicians from 9848 group practices (categorized according to proportion of male physicians ≤50%, >50-75%, >75-90%, and >90%).Main outcome measuresSex differences in physician income in relation to the sex composition of physician practices after multivariable adjustment for physician specialty, years of experience, hours worked, measures of clinical workload, practice type, and geography.ResultsAmong 11 490 non-surgical specialists, the absolute adjusted sex difference in annual income (men versus women) was $36 604 (£29 663; €32 621) (95% confidence interval $24 903 to $48 306; 11.7% relative difference) for practices with 50% or less of male physicians compared with $91 669 ($56 587 to $126 571; 19.9% relative difference) for practices with at least 90% of male physicians (P=0.03 for difference). Similar findings were observed among surgical specialists (n=3483), with absolute adjusted sex difference in annual income of $46 503 ($42 198 to $135 205; 10.2% relative difference) for practices with 50% or less of male physicians compared with $149 460 ($86 040 to $212 880; 26.9% relative difference) for practices with at least 90% of male physicians (P=0.06 for difference). Among primary care physicians (n=3829), sex differences in income were not related to the proportion of male physicians in a practice.ConclusionsAmong both non-surgical and surgical specialists, sex differences in income were largest in practices with the highest proportion of male physicians, even after detailed adjustment for factors that might explain sex differences in income.

Billing Codes Determine Lower Physician Income for Primary Care and Non-Procedural Specialties

The income gap between specialists and primary care physicians and among specialists is well established, but the drivers of this difference are not well delineated. Using the Community Tracking Study (CTS) Physician Survey, we sought to isolate and compare premiums paid to physicians for specialization and the proportion of time spent on offices visit rather than procedures. We divided medical subspecialties according the proportion of Medicare billing for Evaluation and Management (E&M) codes for the specialty as a whole. We report substantial differences in income across physician specialty, and over 70 percent of the difference in income remained controlling for factors that may confound the relationship between income and specialty including gender, location and type of practice, and hours. We note a large variation in premiums for specialization: 11.3–46.8 percent above family medicine after controlling for confounders. Classifying medical subspecialties by E&M billing as procedural versus non-procedural specialties revealed clear income differences. Controlling for confounders, procedural medical specialties earned 37.5 percent more than family medicine, as compared with 15.3 percent for non-procedural medical specialties. This analysis suggests that differences in physician income and resulting incentives are a direct consequence of the payment structure itself, rather than compensation for additional years of training or a reflection of different underlying demographics.

Doctors as Stewards of medicare, or not: CAMSI, MRG, CDM, DRHC and the thin alphabet soup of physician support

Physicians are deeply involved in Canadian medicare because it is through medicare that they are paid. However, from its origins to the present physicians –as a profession – have not been strong supporters of medicare. Fearing loss of income and individual autonomy, they have frequently opposed it with criticisms, strikes, threatened job action and lawsuits. Some opponents are unaware that medicare was a boon to physician income, and many fail to connect medicare with responsibility for improving the health status of the country. This paper will trace physician involvement, support and opposition to medicare from its inception to the present, with special attention to small physician organizations that have supported medicare. It will close with a proposal for how doctors could display greater stewardship.

Financial Incentives to Encourage Value-Based Health Care

This article reviews the literature on the use of financial incentives to improve the provision of value-based health care. Eighty studies of 44 schemes from 10 countries were reviewed. The proportion of positive and statistically significant outcomes was close to .5. Stronger study designs were associated with a lower proportion of positive effects. There were no differences between studies conducted in the United States compared with other countries; between schemes that targeted hospitals or primary care; or between schemes combining pay for performance with rewards for reducing costs, relative to pay for performance schemes alone. Paying for performance improvement is less likely to be effective. Allowing payments to be used for specific purposes, such as quality improvement, had a higher likelihood of a positive effect, compared with using funding for physician income. Finally, the size of incentive payments relative to revenue was not associated with the proportion of positive outcomes.

For Love, Not Money: The Financial Implications of Surgical Fellowship Training

Surgical residents cite “increased income potential” as a motivation for pursuing fellowship training, despite little evidence supporting this perception. Thus, our goal is to quantify the financial impact of surgical fellowship training on financial career value. By using Medical Group Management Association and Association of American Medical Colleges physician income data, and accounting for resident salary, student debt, a progressive tax structure, and forgone wages associated with prolonged training, we generated a net present value (NPV) for both generalist and subspecialist surgeons. By comparing generalist and subspecialist career values, we determined that cardiovascular (ANPV = $698,931), pediatric ($430,964), thoracic ($239,189), bariatric ($166,493), vascular ($96,071), and transplant ($46,669) fellowships improve career value. Alternatively, trauma (-$11,374), colorectal (-$44,622), surgical oncology (-$203,021), and breast surgery (-$326,465) fellowships all reduce career value. In orthopedic surgery, spine ($505,198), trauma ($123,250), hip and joint ($60,372), and sport medicine ($56,167) fellowships improve career value, whereas shoulder and elbow (-$4,539), foot and ankle (-$173,766), hand (-$366,300), and pediatric (-$489,683) fellowships reduce career NPV. In obstetrics and gynecology, reproductive endocrinology ($352,854), and maternal and fetal medicine ($322,511) fellowships improve career value, whereas gynecology oncology (-$28,101) and urogynecology (-$206,171) fellowships reduce career value. These data indicate that the financial return of fellowship is highly variable.