The general decline in physicians' incomes in 1994 masks sizable variation by region and specialty, a new study reports.
Further, those declines-not only for specialists but for some primary-care physicians-can be attributed to levels of managed-care penetration.
"It is a fiction that managed care is the friend of the primary-care physician," said Carol J. Simon, co-author of the study and an associate professor at the University of Illinois at Chicago.
"When we break out primary-care physicians, we find the general internists and pediatricians actually saw their incomes falling," she said. "It was the general-practice and family-practice physicians who did very well. Their earnings went up, and went up in markets that had significant managed care."
These findings ran contrary to the expectations of Simon and her co-author, Patricia Born, an economist at the American Medical Association, when they began the study. They knew that most doctors' incomes declined in 1994 but thought that primary-care doctors were excepted.
Instead, they found that pediatricians' incomes went down 7.2% in 1993-1994 and general internists' incomes dropped 6.4%. General practitioners and family physicians were the only specialty except anesthesiology to see income gains in 1993-1994, of 2%.
The study analyzes data previously released by the AMA taken from its annual telephone survey of 4,000 physicians. Simon and Born's results appear in the fall issue of Health Affairs.
Simon and Born also compared physicians' incomes with degrees of managed-care penetration by state. Primary-care incomes rose only in the states with the lowest penetration; in those states with the highest penetration, their incomes declined.
Subspecialty physicians took an extremely hard fall in the high-managed-care states in 1993-1994. Their incomes declined 10.6%.