Sources of U.S. physician income: the contribution of government payments to the specialist-generalist income gap

J Gen Intern Med. 2008 Sep;23(9):1477-81. doi: 10.1007/s11606-008-0660-7. Epub 2008 Jul 1.


Background: Physician income varies threefold among specialties. Lower incomes have produced shortages in primary care fields.

Objective: To investigate the impact of government policy on generating income differentials among specialties.

Design and participants: Cross-sectional analysis of the 2004 MEPS.

Measurements: For outpatient care, total payments made to 27 different types of specialists from five types of payers: Medicare, Medicaid, other government (the Veterans Administration and other state and local programs), private insurance, and out-of-pocket payments. For inpatient care, aggregate (i.e., all-specialty) inpatient physician reimbursement from the five payers.

Results: In 2004, physicians derived 78.6% of their practice income ($149,684 million, 95% CI, $140,784 million-$158,584 million) from outpatient sources and 21.4% of their income ($40,782 million, 95% CI, $36,839 million-$44,724 million) from inpatient sources. Government payers accounted for 32.7% of total physician income. Four specialties derived > 50% of their outpatient income from public sources, including both the lowest and highest paid specialties (geriatrics and hematology/oncology, respectively).

Conclusions: Inter-specialty income differences result, in part, from government decisions.

MeSH terms

  • Centers for Medicare and Medicaid Services, U.S. / economics
  • Economics, Medical*
  • Fee-for-Service Plans / economics*
  • Fees, Medical
  • Humans
  • Physicians / economics*
  • Specialization / economics*
  • United States
  • United States Department of Veterans Affairs / economics