MGMA: Doctors on "unsustainable course"

Robert Garrison, MD, a family physician in Ventura, Calif., says it seems like every year he's "working harder and making less."

"You get discouraged, and you start thinking do you want to do something else besides private practice," he said.

According to a recent survey by the Medical Group Management Assn., Dr. Garrison is not alone in his lament. The organization's most recent Physician Compensation and Production Survey concluded, as it has the past several years, that primary care physicians' gross charges are greater than their pay increases -- a sign that physicians have to work harder to ensure that they see even a modest bump in pay.

But for the first time, MGMA, which represents mostly small group practices, declares this trend as an "unsustainable course" for primary care physicians. And it says specialists will be immediately on the same course if Congress fails to fix a scheduled 5.1% cut in Medicare payments.

William F. Jessee, MD, president and CEO of MGMA, said the organization's concern is that "primary care physicians are in the unique position of running faster to stay in place."

MGMA's survey found median compensation for primary care doctors increased 3.9%, from $161,816 in 2004 to $168,111 in 2005, while median gross charges rose 6.8%, from $470,901 to $502,746. From 2001 to 2005, data show that productivity grew 20.4%while median compensation increased 12.9%.

Some physician leaders have compared primary care and its place in medicine to a backbone with osteoporosis. "This study shows it's now got compression fractures and developing kyphosis," said Rick Kellerman, MD, president of the American Academy of Family Physicians.

Specialists, by the MGMA's count, are doing better in terms of being able to match pay increases with productivity. According to the survey, from 2004 to 2005 specialists in general saw a 6.6% increase, from $297,000 to $316,620, in median compensation while gross charges were up 6.5%, from $952,284 to $1,014,512. But the survey found that different specialties tended to vary widely year to year in compensation and production figures, so MGMA says those numbers don't necessarily mean an individual practice or specialty is following the overall trend.

For example, James Dove, MD, president-elect of the American College of Cardiologists, says his 45-physician cardiology practice in Springfield, Ill., has lost money over the last seven years.

"Most physicians are maxed out already," he said. "Trying to raise volume is next to impossible."

Dr. Jessee said a medical school dean recently told him about the "ROAD to success" his students routinely refer to: radiology, otorhinolaryngology, anesthesiology and dermatology. Students are not choosing primary care, he said, but instead are flocking to specialties that historically have seen greater compensation gains.

"[But] it looks like Medicare is trying to solve that problem for the specialists," Dr. Jessee said. Besides the 5.1% drop in Medicare fees, other cuts also are scheduled to occur in specialists' services, such as imaging.

The American Medical Group Assn., which represents large groups, released a survey earlier this year showing that physicians in larger practices experienced an increase in compensation in part due to new technology and ancillary service opportunities. But the survey also showed that groups as a whole were losing money.

"The 'ROAD' may be repaved in the future," Dr. Jessee said.

Some doctors are hoping the "unsustainable course" can be changed somewhat through technology or other means to gain efficiency -- though there is wide agreement that improving the health care payment system would go much further in reversing that course.

Dr. Dove is among those cautioning that technology can't be viewed as a fix. He said his cardiology group recently implemented an EMR system. "We gained a little bit of efficiency but nowhere near the cost of implementation," he said.