By NextBestFitRaise primary care pay relative to specialties
Shift fee-schedule dollars from procedures to primary care.
Shifts fee-schedule dollars to primary care.
To review: Specialists lose income.
Review ledgerHow this path connects
This path
Raise primary care pay relative to specialties
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Shift fee-schedule dollars from procedures to primary care
- Change the fee-update committee to include more primary care
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Physician shortage, especially in primary care
Shifting fee-schedule payments from procedures to primary care encourages more students to choose primary care and rewards care most linked to better outcomes.
- Worse outcomes than peer countries despite the highest spending
Shifting payments toward primary care rewards the care most linked to better outcomes.
What it creates or worsens
- Reduces income or business for affected groups
Shifting fee-schedule dollars from procedures to primary care reduces specialist income.
- Takes years, or money up front, before it pays off
Changing payments toward primary care takes years to change the workforce mix.
Who's affected
Who gains
- Residents of areas with too few health professionals
- Physician shortage, especially in primary care: Physician shortages leave them waiting for appointments.
- Doctors, nurses, and other clinicians
- Physician shortage, especially in primary care: Physician shortages contribute to burnout.
- Low- and middle-income households
- Worse outcomes than peer countries despite the highest spending: Poor health outcomes especially affect low-income and minority communities.
- Black, Hispanic, and Native communities
- Worse outcomes than peer countries despite the highest spending: Poor health outcomes especially affect low-income and minority communities.
Who loses
- Specialist clinicians and practices
- Physician shortage, especially in primary care: Scarcity supports incumbent specialists’ pay.
Other ways to soften the losses
- Phase in
Where it has been tried
- UK, Netherlands: GPs earn closer to specialists than in the U.S.
- Germany: In 2021 or the nearest available year, self-employed specialists in Germany earned about 12% more than self-employed general practitioners.Sources: OECD (2023)