Exodus of Men from Primary Care Drives Shift To Medical-Specialty Practice

Women and International Medical Graduates Mask Severity of Shift from Primary Care

News Release
June 29, 2007

FURTHER INFORMATION, CONTACT:
Alwyn Cassil (202) 264-3484 or acassil@hschange.org

WASHINGTON, DC—An exodus of men from primary care practice is driving a marked shift in the physician workforce toward such specialties as cardiology and dermatology, reinforcing concerns about a looming shortage of primary care physicians, according to a new national study released today by the Center for Studying Health System Change (HSC).

Two factors have helped mask the severity of the shift from primary care—a growing proportion of female physicians, who disproportionately choose primary care, and continued reliance on international medical graduates (IMGs), who now account for nearly a quarter of all U.S. primary care physicians, according to the study.

Since 1996-97, a 40 percent increase in the female primary care physician supply has helped to offset a 16 percent decline in the male primary care physician supply relative to the U.S. population, the study found. At the same time, primary care physicians’ incomes have lost ground to both inflation and medical and surgical specialists’ incomes. And women in primary care face a 22 percent income gap relative to men, even after accounting for differing characteristics.

"If real incomes for primary care physicians continue to decline, there is a risk that the migration of male physicians will intensify and that female physicians may begin avoiding primary care—trends that could aggravate a predicted shortage of primary care physicians," said Paul B. Ginsburg, president of HSC, a nonpartisan policy research organization funded principally by the Robert Wood Johnson Foundation.

"As the U.S. population ages and many of the 76 million baby boomers develop multiple chronic conditions, an adequate supply of primary care physicians will be critical to meet the nation’s health care needs," said HSC Senior Researcher Ha T. Tu, M.P.A., coauthor of the study with HSC Senior Researcher Ann O’Malley, M.D., M.P.H.

Over the last decade, the supply of medical specialists, such as cardiologists and gastroenterologists, has increased significantly, while the supply of both primary care physicians and surgeons has declined, according to the study. Among physicians providing direct patient care at least 20 hours a week, the proportion of medical specialists grew from 32.2 percent in 1996-97 to 37.6 percent in 2004-05, while the proportion of primary care physicians decreased from 38.9 percent to 36.7 percent. Likewise, the proportion of surgeons declined from 28.9 percent to 25.7 percent.

Based on HSC’s nationally representative Community Tracking Study Physician Survey, the study’s findings are detailed in a new HSC Tracking Report—Exodus of Male Physicians from Primary Care Drives Shift To Specialty Practice—available here. The 1996-97 and 2000-01 surveys contain information on about 12,000 patient-care physicians, and the 2004-05 survey includes responses from more than 6,600 physicians. Response rates for the surveys range from 52 percent to 65 percent. Other key study findings include:

• Overall, from 1996-97 to 2004-05, there was a modest increase in the patient-care physician population relative to the U.S. population—131.9 physicians per 100,000 people in 1996-97 compared with 136.2 physicians per 100,000 people in 2004-05. However, the number of primary care physicians per capita fell slightly as the number of male primary care physicians declined significantly from 39.3 per 100,000 people in 1996-97 to 33.0 per 100,000 in 2004-05. Without the increase in the supply of female primary care physicians—from 12.1 per 100,000 in 1996-97 to 17.0 per 100,000 in 2004-05—a larger reduction in the primary care workforce relative to the population would have occurred.
• Women accounted for a quarter of all patient-care physicians in 2004-05, up from 18 percent in 1996-97. Female physicians are much more prevalent in primary care—more than one in three primary care physicians is a woman, compared with 22 percent of medical specialists and 17 percent of surgeons. And, among female physicians in 2004-05, half practiced in primary care, one-third in medical specialties, and only 17 percent in surgical specialties
• Nearly one-fourth of the primary care physician workforce is composed of international medical graduates, whose share of the primary care workforce has remained stable at just more than 24 percent since 2000-01, after increasing from 20.7 percent in the late-1990s.
• On average, female primary care physicians earned about 30 percent less than their male counterparts in 2003—average reported net income of $114,316 vs. $162,934.
• Male-female income gaps persisted even after controlling for personal and practice characteristics, including specialty, years of experience, board certification, IMG status, average hours worked, practice setting, proportions of Medicaid and capitated revenue, and practice ownership status. Adjusted incomes (controlling for personal and practice characteristics) revealed a 22 percent gender gap in 2003 for primary care physicians-a gap that has widened since 1995, when it was 16 percent. In contrast, women in the medical specialties have reduced the income gap considerably relative to their male counterparts.

The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nation’s changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.