Generalist physicians in managed-care plans tend to earn more now than they did three years ago, while surgical specialists are earning less, according to preliminary data from a new survey.
Conducted by the consulting firm Mathematica Policy Research for the Physician Payment Review Commission, the survey showed that more than 60% of plans say compensation to their family practice, general internal medicine and pediatric physicians has increased compared with what all their plan physicians were paid three years ago. Less than 10% of plans said compensation to those three categories decreased.
The report is based on 1994 salaries, but exact dollar amounts were not immediately available.
Meanwhile, nearly half the plans surveyed said compensation to their surgical specialists went down, and less than 20% of plans said compensation to surgeons increased compared with what all plan physicians were paid three years ago.
Princeton, N.J.-based Mathematica this summer polled 100 managed-care plans in 20 markets to help the commission-which advises Congress on Medicare physician payment issues-understand how managed care will affect physicians' practices.
So far, Mathematica has partial and preliminary data from 82 plans, including 21 group/staff-model HMOs, 46 networks or independent practice associations, and 15 PPOs covering some 25 million patients.
The compensation data are one of several indicators suggesting the role of primary-care physicians is bigger in managed-care plans, especially HMOs.
Marsha Gold, senior researcher for Mathematica in Washington, told the PPRC that most of the plans the firm surveyed also require patients to choose a primary-care physician, and nearly all HMOs make the primary-care physician responsible for referring patients to specialists.
About half the plans said they have taken specific steps to change primary-care physicians' scope of practice, and most changes of scope were reported as moderate.
Spokesmen for groups representing primary-care physicians and group practices said they were not surprised by Mathematica's findings.
Charles Huntington, Washington office director for the American Academy of Family Physicians, said his group's annual survey of 4,000 members shows that the mean salary of physicians on straight salary, usually those in HMOs, rose about 25% between 1989 and 1992, to $90,000 from $72,000.
The mean salary for primary-care physicians in a fee-for-service setting, however, rose only about 2.3% over the same period, to $113,200 from $110,700. Mr. Huntington said.
Brent Miller, government relations director for the American Group Practice Association, said managed-care plans are trying to favor primary care in their payment packages in much the same way Medicare has in its existing physician fee schedule.
"Competitive health plans are incorporating in their compensation systems reimbursement strategies that at least parallel the intent of (the physician fee schedule) to redistribute relative income increases to primary-care providers," Mr. Miller said.
He added that such compensation policies will encourage medical school students to enter primary-care practices and eliminate an oversupply of specialists "far faster than Congress can ever hope to do it."