The wealth gap: are cardiologists’ high salaries standing in the way of primary care?

High salaries for cardiologists and other specialists lead to an overwhelming lifetime advantage in wealth accumulation, according to a new study appearing in Health Affairs. That advantage may play a decisive role in the choice of medical careers, say Kevin Schulman and his colleagues in their article, “Can We Close The Income And Wealth Gap Between Specialists And Primary Care Physicians?”

The Duke researchers compared specialists, represented by cardiologists (who have the 14th highest median practice income among 68 medical specialties), to primary care physicians, represented by general internists and family physicians, as well as other non-physicians. Here is their estimated value of career wealth from college graduation until age 65:

  • Cardiologist: $5.2 million
  • Primary care physicians: $2.5 million
  • MBA graduate: $1.7 million
  • Physician Ass’t (PA): $850,000
  • College graduate: $340,000

Schulman and colleagues noted that even though the primary care physicians (PCPs) didn’t do as well as the cardiologists, they fared better than MBAs, PAs, and plain vanilla college graduates.

The advantages for the cardiologists held up under a wide variety of assumptions and variables. Despite their early front-loaded accumulation of debt, for instance, “a cardiologist who retired at age 49 would have more wealth at age 65 than a primary care physician who worked until age 65.”

Here’s another example: “the cardiologist could live at twice the level of annual living expenses from age twenty-two onward, accumulating more than $625,000 in debt, and still generate more career wealth than a primary care physician living at the base level of living expenses.”

Although the gap between cardiologists and PCPs is striking, the authors note that “both specialist and primary care physicians are well rewarded for investments in professional training compared with the other career choices.” Further, according to some sources, US physicians are “overcompensated in comparison” with physicians in other countries.

The authors reject one proposed solution– much to the relief of some CardioBrief readers, I’m sure– to close the gap by reducing specialists’ salaries, noting it is “difficult politically” and that previous efforts to do so have not been successful.

Dramatic changes in wealth accumulation may not be politically possible and may not be necessary, the authors suggest. Immediate or short-term rewards may have the desired impact: “it is possible that small but immediate gains, such as debt forgiveness or bonus payments, could affect the decision to specialize beyond the long-term economic impact.” This idea is supported by other studies showing that medical students with high debt levels were less likely to choose primary care.

See also a story on the Duke study by Julie Rovner on the NPR Health Blog.

Previous CardioBrief stories on cardiology salaries:

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  2. john kane says:

    john kane

    The wealth gap: are cardiologists’ high salaries standing in the way of primary care?

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