Advocacy & Practice Updates — Advocacy & Practice
Literature Update: Study Finds Increasing Primary Care Pay Worsens Specialist Shortages
In a study published last week in the journal Health Affairs, the authors review the decades-long effort to increase physician reimbursement for primary care—often at the expense of surgical specialties—and find that these investments have not delivered the increased supply of providers or better health outcomes policymakers sought. With recent increased investments such as revalued E/M codes and add-on payments for complex or post-acute care patients, U.S.-based primary care physicians are better compensated than their counterparts in other countries with patients experiencing similar access. Despite this, health outcomes have not improved overall, and medical students consistently name factors other than compensation in choosing other specialties.
Most troubling, the study highlights the unique feature of budget neutrality in the physician fee schedule that requires Medicare to maintain an overall level of spending. When certain services experience significant increases in value or utilization, this rule requires that all other services be reduced to maintain neutrality. Frequent efforts to boost primary care payment have meant retina and other surgical services have seen consistent cuts in recent years. The study points to these accumulated cuts as a key factor in specialty shortages that threaten patient access. The study authors recommend policymakers study these shortages before implementing further reforms that favor primary care.
(Published 5.12.26)