Researchers at the University of Illinois at Chicago report that primary care physician's income grew more rapidly in states with the highest managed care growth compared to states with the lowest managed care growth. In contrast, specialist incomes, in particular those of radiologists, anesthesiologists, and pathologists grew most rapidly in states with the lowest managed care growth and least rapidly in states with the highest managed care growth.
The study examined the impact of managed care on the employment and compensation of primary care and specialty physicians as measured by changes in income, physician-to-population ratios, and choices of specialty. The researchers used data from the American Medical Association's Socioeconomic Monitoring System survey, a nationally representative 1% random sample of post-residency patient care physicians, and location data from the AMA Masterfile.
They evaluated the relationship between growth in managed care from 1985 to 1993 and:
- inflation-adjusted physician incomes
- physician-to-population ratios for primary care and specialist physicians.
Primary care income grew 4.78% annually ($33,526 cumulatively) in states with the highest managed care growth, compared to 1.20% ($7448 cumulatively) in states in the lowest quartile of managed care growth states. For radiologists, anesthesiologists, and pathologists, income rose only 0.14% ($1700) in the top quartile of states for managed care growth versus 4.14% ($58,558) in the lowest quartile of states. These states with lowest managed care growth also experienced the fastest growth in the ratio of radiologists, anesthesiologist, and pathologists per capita. Between 1989 and 1995 the number of family practice and pediatric residency slots filled increased 32% while specialist positions in medicine and surgery showed no growth and the number of radiologist, anesthesiologist and pathologist positions declined by 14%.
The tables and charts place the 50 states and the District of Columbia in quartiles by growth in managed care penetration and then describe the physician income and supply trends for primary care doctors and specialists in these quartiles. National data on the number of residency positions offered and filled for family medicine and pediatrics, medical and surgical specialists, and radiologists, anesthesiologists, and pathologists are also presented.