Wednesday, June 01, 2005

Recent physician compensation data will discourage general internal medicine as career

The latest data from Delta Medical Consulting (www.deltamed.com) places general IM, Peds,and FP at the lower strata of the medical compensation pecking order. This should not be a surprise to anyone but the magnitude of the difference between a general internist and medical subspecialties has to be of concern to medical graduates considering a career in internal medicine.
Using rounded figures the following are the starting annual compensations as published by Delta.
internal medicine 166,000
cardiology 323,000
oncology 337,000
gi 358,000
pulmonary 248,000
endo 172,000
hospitalist 179,000
Cardiologists, oncologists and GI docs make about twice as much for two years more training and pulmonary docs do ok. EM docs makes about 237,000.(You can view the entire survey by going to the Delta Consulting site and hitting the "show me" button.)
Delta also provides current average locum tenens bill rate per 8 hour day and, of course, they show a similar ordinal ranking. But it gets worse. While the internist,FP and ped all make $760 per day, the CRNA brings in $ 1,140 and a hospitalist makes $975. An internist has to sub specialize to make more than an anesthesia nurse. If lack of prestige is one factor in not choosing general IM, that fact should resonate in the limbic cortex's self esteem circuits.
A recent study quoted in Amednews.com indicates only 19% of first year residents choose primary care. Dr. Roy Poses in hcrenewal has written about this ( May 24 th posting) and quotes more data and although a number of educators and internal medicine leaders have expressed concerns, I have heard no convincing or realistic plans to change things. It is not just the money but income obviously is very important and so are med school loan obligations.
The subspecialist will only have to keep current in his field not with everything and everything gets more and more impossible. Many of us feel less stressed when we have limited the universe of information about which we are obligated to be expert. Further, the general internist has competition not only from FP docs but from NPs, a situation not an issue for the subspecialist. The subspecialist can dabble (I know that is probably too strong a pejorative) in as much or as little general IM as her interests and comfort level allows and send the rest back to the primary care doctor or other subspecialist.

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