Medicare blamed for shortage of primary care doctors

Ronald Reagan once said "The nine most terrifying words in the English language are: 'I'm from the government and I'm here to help.' "

Cambridge doctors light years away on the political spectrum from the conservative president have written a paper that also casts the government as part of a problem. Drs. Karen Lasser, Steffie Woolhandler, and David Himmelstein of Cambridge Health Alliance plant blame for pay gaps between specialists and generalists squarely on the government, saying its policies help perpetuate a primary care physician shortage.

The doctors, who in other arenas have favored a government-funded single-payer system something like Canada's, analyzed payment data for outpatient visits and found that government sources, including Medicaid and Medicare, make up one-third of total physician income. They conclude that changes in how the government reimburses doctors could reduce gaps that in the case of geriatricians mean they are paid an average of $165,000 a year while hematologists get $504,000. Geriatricians provide primary care for elderly people while hematologists specialize in diseases of the blood, including cancer. For both geriatricians and hematologists, government payments make up more than half of their income.

Their paper, in the online Journal of General Internal Medicine, reports on data from the 2005 Medical Expenditure Panel Survey, which was sponsored by two federal agencies. The income differences they found held true even after expenses for malpractice insurance and medical equipment were accounted for, the authors said.

"Even lower-paid US physicians earn far more than the average American, making it difficult to generate a groundswell of public sympathy for the financial plight of primary care doctors," they write. "Yet the income inequality between the specialists and generalists unbalances the health care system and ultimately puts patients at risk.... Ironically, Medicare's priority population, the elderly, is vastly underserved, in part because of Medicare's own payment policies."