Physicians in primary and specialized care each provide important but different roles in the medical field. However, physicians in primary care are paid significantly less than specialized physicians, and this gap has major and lasting negative effects on the healthcare system as a whole.

According to a 2022 report from Medscape, primary care physicians (PCPs) on average make $260,000, while specialists make $368,000 annually, with plastic surgeons having the highest salaries of the field at $576,000. The $100,000 disparity means that medical students and training physicians generally choose to go into a specialized field to get a higher pay than if they went into primary care, leading to a shortage of PCPs. In fact, the Milbank Memorial Fund states that the ratio of PCPs to the population declined from 68.4 to 67.2 per 100,000 people between 2012 and 2021.

The shortage of PCPs creates heavier workloads for current PCPs. A 2023 study by the Journal of the American Medical Association Health Forum found that PCPs’ workload leaves each patient with only about 19 minutes for their visits, with the lower quartile spending as little as 14 minutes per patient. Nineteen minutes is not enough time for a full and thorough look at a patient’s health. Because a primary physician needs to look at a patient’s general physical health, perform a general evaluation of their mental health and apply diagnosis, this lack of time leads to major mental disorders or physical problems going undiagnosed and untreated. The intense workload PCPs face without the same compensation as a specialist dissuades future physicians from the PCP path and worsens the shortage that causes this heavy workload in the first place.

Additionally, The National Institute of Health expects demand for PCPs to increase and the amount of adults over 50 with at least one chronic disease to double between 2020 and 2050. The rising number of patients needing PCPs to evaluate their symptoms and diagnose them will cause a crisis in the healthcare system. The United States has many patients needing general care from primary physicians, making the pay gap-caused shortage prove more precarious with time. 

With continually more patients and fewer physicians, the shortage and the issues it causes, as well as the pay gap between PCPs and specialized care physicians continues to grow. Companies running primary care cannot raise their physicians’ pay without the investment money. However, investment in primary care from insurance companies continues to decline since 2019 according to Milbank Memorial Fund. The rising scarcity of primary care physicians with the rising demand means higher costs for patients. Costs for healthcare are already unaffordable for a significant portion of the population, and beyond the COVID spike, prices have continued to climb since before 2015.

Imagine a surgeon preparing for a complex operation, knowing that every decision and movement could have a life-or-death consequence. Meanwhile, a primary care physician (PCP) manages a busy day of consultations, helping patients prevent illness and navigate health issues. Both are crucial in the health care system, but specialists face a unique challenge that justifies higher compensation.

Specialists undergo years of advanced education to gain the expertise needed to treat complex conditions. According to Cleveland Clinic, a specialist like an interventional cardiologist typically spends over 11 years in training after college, including medical school, residency and fellowships. This extensive training equips them with in-depth knowledge in specific areas of medicine, allowing them to manage conditions that are often rare or require intricate treatments, like cardiac catheterization. In contrast, PCPs undergo a broader but shorter training of seven  years, preparing them to handle a wide variety of general health issues, but without the same level of specialized expertise. Specialists handle more specific and advanced cases, which require deeper understanding and precision than primary care physicians, making their expertise more valuable and deserving of higher pay.

Specific areas of medical care, like cardiology or oncology, often require significantly more time to treat than primary care. While PCPs also face long workdays, specialists often work longer hours due to performing various, and often complicated, procedures. According to the American Medical Association, specialists frequently work over 60 hours a week, while PCPs typically work around 50 hours. Moreover, specialists are often on-call for emergencies, requiring them to dedicate additional time and attention outside of regular hours. This high level of responsibility, combined with the unpredictability of their duties, underscores why specialists should be compensated more.

The heightened risk and stress associated with specialist roles also justifies their higher pay. Specialists often deal with high-stakes situations where mistakes can have severe, life-altering consequences. Surgeons often perform operations that involve considerable risk, and complications during or after surgery can significantly impact a patient’s outcome. For example, a craniotomy, a neurosurgical procedure where a part of the skull is removed to access the brain, can have large risks and can be life threatening. Furthermore, specialists often handle emergencies requiring immediate, high-pressure decisions, such as trauma cases. This level of responsibility, coupled with the emotional toll of patient outcomes, places a large burden on specialists, making their higher compensation deserving.

Overall, the compensation disparity between specialists and PCPs is warranted by their extensive training, long work hours and heightened responsibilities. These professionals dedicate a significantly large amount of time, energy and skill to treat complex cases often under intense pressure and with serious consequences. For these reasons, specialists should continue to earn more than PCPs as a reflection of the valuable and high-risk nature of their work.