Physicians in the United States

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U.S. physicians per 10,000 people, 1850-2009 Physicians in the United States per 10,000 people (1850-2009).svg
U.S. physicians per 10,000 people, 1850-2009

Physicians are an important part of health care in the United States. The vast majority of physicians in the US have a Doctor of Medicine (MD) degree, though some have a Doctor of Osteopathic Medicine (DO), or Bachelor of Medicine, Bachelor of Surgery (MBBS).

Contents

The American College of Physicians, uses the term physician to describe specialists in internal medicine, while the American Medical Association uses the term physician to describe members of all specialties.

Trends related to a physician shortage in the U.S. have generated discussion by the American news media in publications such as Forbes , [1] The Nation , [2] and Newsweek . [3]

Working conditions

A surgeon, writer, and public health researcher, Dr. Gawande is known for his contributions to healthcare quality, patient safety, and end-of-life care. He has authored several bestselling books and articles on healthcare reform and medical ethics. Atul Gawande, USAID Assistant Administrator.jpg
A surgeon, writer, and public health researcher, Dr. Gawande is known for his contributions to healthcare quality, patient safety, and end-of-life care. He has authored several bestselling books and articles on healthcare reform and medical ethics.

Doctors may work independently, as part of a larger group practice, or for a hospital or healthcare organization. Independent practices are defined as one in which the physician owns a majority of his or her practice and has decision making rights. In 2000, 57% of doctors were independent, but this decreased to 33% by 2016. Between 2012 and 2015, there was a 50% increase in the number of physicians employed by hospitals. [4] 26 percent have opted out of seeing patients with Medicaid and 15 percent have opted out of seeing patients with health insurance exchange plans. [5]

On average, physicians in the US work 55 hours each week and earn a salary of $270,000, although work hours and compensation vary by specialty. [6] 25% of physicians work more than 60 hours per week. [7]

Demographics

While an impending "doctor shortage" has been reported, from 2010 to 2018, the actively licensed U.S. physician-to-population ratio increased from 277 to 301 physicians per 100,000 people. Additionally, the number of female physicians, and osteopathic and Caribbean graduates have increased at a greater percentage. [8] [9]

As of 2018, there were over 985,000 practicing physicians in the United States. 90.6% have an MD degree, and 76% were educated in the United States. 64% were male. 82% were licensed in a medical specialty. 22% held active licenses in two or more states. [8] [10] The percentage of females skews younger. In 2018, 33% of female physicians were under 40 years old, compared with 19% of male physicians. [8] The District of Columbia has, by far, the largest number of physicians as a percentage of the population, with 1,639 per 100,000 people. [8] Additionally, Among active physicians, 56.2% identified as White, 17.1% identified as Asian, 5.8% identified as Hispanic, 5.0% identified as Black, and 0.3% identified as American Indian/Alaska Native.

Specialists

A neurosurgeon, medical reporter, and CNN's chief medical correspondent, Dr. Gupta is known for his ability to communicate complex medical information to the public. Sanjay Gupta (cropped).jpg
A neurosurgeon, medical reporter, and CNN's chief medical correspondent, Dr. Gupta is known for his ability to communicate complex medical information to the public.

The term, hospitalist, was introduced in 1996, [11] to describe US specialists in internal medicine who work largely or exclusively in hospitals. Such 'hospitalists' now make up about 19% of all US general internists. [12]

There are three agencies or organizations in the United States which collectively oversee physician board certification of medical and osteopathic physicians in the United States in the 26 approved medical specialties recognized in the country. These organizations are the American Board of Medical Specialties and the American Medical Association; the American Osteopathic Association Bureau of Osteopathic Specialists and the American Osteopathic Association; the American Board of Physician Specialties and the American Association of Physician Specialists. Each of these agencies and their associated national medical organization functions as its various specialty academies, colleges, and societies.

All boards of certification now require that medical practitioners demonstrate, by examination, continuing mastery of the core knowledge and skills for a chosen specialty. Recertification varies by particular specialty between every eight and ten years. [13]

Salaries

Pay gap by gender and race

Mona Hanna-Attisha pediatrician and public health advocate, Dr. Hanna-Attisha played a crucial role in uncovering the Flint water crisis and advocating for the health of children affected by lead poisoning. Mona2x.jpg
Mona Hanna-Attisha pediatrician and public health advocate, Dr. Hanna-Attisha played a crucial role in uncovering the Flint water crisis and advocating for the health of children affected by lead poisoning.

The average salary for white male physicians was $253,000 compared with $188,230 for black male physicians, $163,000 for white female physicians, and $153,000 for black female physicians. [14] [15]

Medscape's 2019 Physician Compensation Report found that "males out-earned their female counterparts in both primary care and specialist positions with men earning 25% and 33% more, respectively." [16] [17] [18]

The AMA has advocated to reduce gender bias and close the pay gap. [19] The AMA said that “significant sex differences in salary exist even after accounting for age, experience, specialty, faculty rank, and measures of research productivity and clinical revenue.” [18] A 2015 study of gender pay disparities among hospitalists found that women were more likely to be working night shifts despite having lower salaries. In 2018, the AMA delegates advocated for transparency in defining the criteria for initial and subsequent physician compensation, that pay structures be based on objective, gender-neutral objective criteria, and that institutes take a specified approach using metrics for all employees to identify gender disparity. [20]

The AMA has also advocated to move USMLE Step 1 to pass/fail to decrease racial bias. A 2020 study showed lack of diversity within specialities and that that underrepresented students were more likely to go into specialities that have lower Step 1 cut offs like Primary Care. [21]

Pay cuts due to COVID

One in five physicians reported having a pay cut during the COVID-19 pandemic. The majority of the monetary loss was a result of low volume of patients and lack of elective surgeries. [22] [23]

Compared to foreign countries

The United States has the highest paid general practitioners in the world. [24] The US has the second-highest paid specialists in the world behind the Netherlands. [24] Public and private payers pay higher fees to US primary care physicians for office visits (overall 27 percent more for public and 70 percent more for private) than in Australia, Canada, France, Germany and the United Kingdom. [25] US primary care physicians also earn more (overall earning $186,000 yearly) than the foreign counterparts, with even higher numbers for physician compensation for medical specialists. [25] Higher fees, rather than factors such as higher practice costs, volume of services, or tuition expenses, mainly drive higher US spending. [25]

Variations within the US

Mehmet Oz cardiothoracic surgeon and host of "The Dr. Oz Show," Dr. Oz is known for his advocacy of alternative medicine and holistic health practices. Mehmet Oz - World Economic Forum Annual Meeting 2012.jpg
Mehmet Oz cardiothoracic surgeon and host of "The Dr. Oz Show," Dr. Oz is known for his advocacy of alternative medicine and holistic health practices.

A 2011 survey of 15,000 physicians practicing in the United States reported that, across all specialties, male physicians earned approximately 41% more than female physicians. [26] Also, female physicians were more likely to report working fewer hours than their male counterparts. [26]

The same survey reported that, the highest-earning physicians were located in North Central region, comprising Kansas, Nebraska, North and South Dakota, Iowa, and Missouri, with a median salary of $225,000 per year, as per 2010. The next highest earning physicians were those in the South Central region, comprising Texas, Oklahoma, and Arkansas, at $216,000. Those physicians reporting the lowest compensation levels were located in the Northeast and Southwest, earning an across-specialty median annual income of $190,000. [26]

The survey concluded that physicians in small cities (50,000–100,000) earned slightly more than those living in community types of other sizes, ranging from metropolitan to rural, but the differences were only marginal (a few percent more or less). [26]

Other results from the survey were that those running a solo practice earned marginally less than private practice employees, who, in turn, earned marginally less than hospital employees. [26]

The Bureau of Labor Statistics reports mean annual income for physicians at $251,990, and mean annual income for surgeons at $337,980, as of 2022. [27]

Medical education

The US medical education for physicians includes participation in a US medical school that eventually grants a US form of Doctor of Medicine (M.D.) degree [28] or a Doctor of Osteopathic Medicine degree. [29] During the process of medical school, physicians who wish to practice in the U.S. must take standardized exams, such as the United States Medical Licensing Examination steps 1, 2 and 3 or Comprehensive Osteopathic Medical Licensing Examination Level 1, 2, and 3.

In addition, the completion of a residency is required to practice independently. Residency is accredited by the ACGME and is the same regardless of degree type. After residency, physicians can become board certified by their specialty board. Physicians must have a medical license to practice in any state.

See also

Further reading

Related Research Articles

<span class="mw-page-title-main">Physician</span> Professional who practices medicine

A physician, medical practitioner, medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the study, diagnosis, prognosis and treatment of disease, injury, and other physical and mental impairments. Physicians may focus their practice on certain disease categories, types of patients, and methods of treatment—known as specialities—or they may assume responsibility for the provision of continuing and comprehensive medical care to individuals, families, and communities—known as general practice. Medical practice properly requires both a detailed knowledge of the academic disciplines, such as anatomy and physiology, underlying diseases and their treatment—the science of medicine—and also a decent competence in its applied practice—the art or craft of medicine.

<span class="mw-page-title-main">Emergency medicine</span> Medical specialty concerned with care for patients who require immediate medical attention

Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians specialize in providing care for unscheduled and undifferentiated patients of all ages. As first-line providers, in coordination with emergency medical services, they are primarily responsible for initiating resuscitation and stabilization and performing the initial investigations and interventions necessary to diagnose and treat illnesses or injuries in the acute phase. Emergency medical physicians generally practice in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units. Still, they may also work in primary care settings such as urgent care clinics.

In the medical profession, a general practitioner (GP) or family physician is a doctor who is a consultant in general practice. GPs have distinct expertise and experience in providing whole person medical care whilst managing the complexity, uncertainty and risk associated with the continuous care they provide. GPs work at the heart of their communities, striving to provide comprehensive and equitable care for everyone, taking into account their health care needs, stage of life and background. GPs work in, connect with and lead multidisciplinary teams that care for people and their families, respecting the context in which they live, aiming to ensure all of their physical and mental health needs are met. They are trained to treat patients to levels of complexity that vary between countries. The term "primary care physician" is more usually used in the US.

Osteopathic medicine is a branch of the medical profession in the United States that promotes the practice of science-based medicine, often referred to in this context as allopathic medicine, with a set of philosophy and principles set by its earlier form, osteopathy. Osteopathic physicians (DOs) are graduates of American osteopathic medical colleges and are licensed to practice the full scope of medicine and surgery in all 50 US states. The field is distinct from osteopathic practices offered in nations outside of the U.S., whose practitioners are generally not considered part of core medical staff nor of medicine itself, but rather are alternative medicine practitioners. The other major branch of medicine in the United States is referred to by practitioners of osteopathic medicine as allopathic medicine.

<span class="mw-page-title-main">Primary care</span> Day-to-day health care given by a health care provider

Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care that the patient may need. Patients commonly receive primary care from professionals such as a primary care physician, a physician assistant, a physical therapist, or a nurse practitioner. In some localities, such a professional may be a registered nurse, a pharmacist, a clinical officer, or an Ayurvedic or other traditional medicine professional. Depending on the nature of the health condition, patients may then be referred for secondary or tertiary care.

Hospital medicine is a medical specialty that exists in some countries as a branch of family medicine or internal medicine, dealing with the care of acutely ill hospitalized patients. Physicians whose primary professional focus is caring for hospitalized patients only while they are in the hospital are called hospitalists. Originating in the United States, this type of medical practice has extended into Australia and Canada. The vast majority of physicians who refer to themselves as hospitalists focus their practice upon hospitalized patients. Hospitalists are not necessarily required to have separate board certification in hospital medicine.

<span class="mw-page-title-main">Residency (medicine)</span> Postgraduate medical training

Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician, veterinarian, dentist, podiatrist (DPM) or pharmacist (PharmD) who practices medicine, veterinary medicine, dentistry, podiatry, or clinical pharmacy, respectively, usually in a hospital or clinic, under the direct or indirect supervision of a senior medical clinician registered in that specialty such as an attending physician or consultant. In many jurisdictions, successful completion of such training is a requirement in order to obtain an unrestricted license to practice medicine, and in particular a license to practice a chosen specialty. In the meantime, they practice "on" the license of their supervising physician. An individual engaged in such training may be referred to as a resident, registrar or trainee depending on the jurisdiction. Residency training may be followed by fellowship or sub-specialty training. Whereas medical school teaches physicians a broad range of medical knowledge, basic clinical skills, and supervised experience practicing medicine in a variety of fields, medical residency gives in-depth training within a specific branch of medicine.

<span class="mw-page-title-main">Family medicine</span> Medical specialty

Family medicine is a medical specialty within primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary care physician, is named a family physician. It is often referred to as general practice and a practitioner as a general practitioner. Historically, their role was once performed by any doctor with qualifications from a medical school and who works in the community. However, since the 1950s, family medicine / general practice has become a specialty in its own right, with specific training requirements tailored to each country. The names of the specialty emphasize its holistic nature and/or its roots in the family. It is based on knowledge of the patient in the context of the family and the community, focusing on disease prevention and health promotion. According to the World Organization of Family Doctors (WONCA), the aim of family medicine is "promoting personal, comprehensive and continuing care for the individual in the context of the family and the community". The issues of values underlying this practice are usually known as primary care ethics.

In the United Kingdom, junior doctors are qualified medical practitioners working whilst engaged in postgraduate training. The period of being a junior doctor starts when they qualify as a medical practitioner following graduation with a Bachelor of Medicine, Bachelor of Surgery degree and start the UK Foundation Programme. It culminates in a post as a consultant, a general practitioner (GP), or becoming a SAS Doctor, such as a specialty doctor or Specialist post.

A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include those branches of medicine that deal exclusively with children (paediatrics), cancer (oncology), laboratory medicine (pathology), or primary care. After completing medical school or other basic training, physicians or surgeons and other clinicians usually further their medical education in a specific specialty of medicine by completing a multiple-year residency to become a specialist.

<span class="mw-page-title-main">Medical education in Australia</span> Summary of education and training of medical practitioners (doctors) in Australia.

Medical education in Australia includes the educational activities involved in the initial and ongoing training of Medical Practitioners. In Australia, medical education begins in Medical School; upon graduation it is followed by a period of pre-vocational training including Internship and Residency; thereafter, enrolment into a specialist-vocational training program as a Registrar eventually leads to fellowship qualification and recognition as a fully qualified Specialist Medical Practitioner. Medical education in Australia is facilitated by Medical Schools and the Medical Specialty Colleges, and is regulated by the Australian Medical Council (AMC) and Australian Health Practitioner Regulation Agency (AHPRA) of which includes the Medical Board of Australia where medical practitioners are registered nationally.

<span class="mw-page-title-main">Medical education in the United States</span> Educational activities training physicians in the United States

Medical education in the United States includes educational activities involved in the education and training of physicians in the country, with the overall process going from entry-level training efforts through to the continuing education of qualified specialists in the context of American colleges and universities.

An international medical graduate (IMG), earlier known as a foreign medical graduate (FMG), is a physician who has graduated from a medical school outside of the country where he or she intends to practice. The term non-local medical graduate may be similarly used in countries with distinct licensing regions within them. Generally, the medical school of graduation is one listed in the World Directory of Medical Schools (WDOM) as accredited by the Foundation for Advancement of International Medical Education and Research or the World Health Organization.

The Federation of State Medical Boards (FSMB) of the United States is a national non-profit organization that represents the 71 state medical and osteopathic boards of the United States and its territories and co-sponsors the United States Medical Licensing Examination. Medical boards license physicians, investigate complaints, discipline those who violate the law, conduct physician evaluations, and facilitate the rehabilitation of physicians where appropriate. The FSMB's mission calls for "continual improvement in the quality, safety and integrity of health care through the development and promotion of high standards for physician licensure and practice."

<span class="mw-page-title-main">Humayun Chaudhry</span> American physician and medical educator

Humayun Javaid Chaudhry, D.O., MACP, FRCP (Lon.), FRCP (Edin.) is an American physician and medical educator who is president and chief executive officer of the Federation of State Medical Boards (FSMB) of the United States, a national non-profit organization founded in 1912 that represents the 70 state medical boards of the United States and its territories and which co-sponsors the United States Medical Licensing Examination (USMLE). From 2007 to 2009, he served as Commissioner of Health Services for Suffolk County, New York, the state's most populous county outside New York City. In 2016, he was listed by Modern Healthcare magazine as one of the 50 Most Influential Physician Executives and Leaders.

The American Board of Hospital Medicine (ABHM) is a Member Board of the American Board of Physician Specialties (ABPS), the nation's third largest physician multispecialty certifying organization and was founded in 2009. The ABHM is North America's first and only board of certification devoted exclusively to hospital medicine founded by hospitalists and governed by hospitalists.

<span class="mw-page-title-main">Veterinary medicine in the United States</span> Medical treatment of animals in the United States

Veterinary medicine in the United States is the performance of veterinary medicine in the United States, normally performed by licensed medical professionals, and subject to provisions of statute law which vary by state. Veterinary medicine is normally led by veterinary physicians, termed veterinarians or vets, but also by paraveterinary workers, such as veterinary technicians, and veterinary assistants. This can be augmented by other paraprofessionals with specific specialties, such as animal physiotherapy or dentistry, and species-relevant roles such as farriers.

IPC Healthcare, previously known as IPC The Hospitalist Company, was a publicly traded corporation which operates a national physician group practice focused on the delivery of hospital medicine and related facility-based services. IPC providers manage the care of patients in coordination with primary care physicians and specialists in over 1,900 facilities in 28 states across the U.S. The company name is derived from an earlier company called In-Patient Consultants Management, Inc. and the NASDAQ ticker name was changed to IPCM in 2008. The company changed its name to IPC Healthcare in January 2015. The company was acquired by TeamHealth in 2015 for $1.6 billion.

Post-Hospitalist Medicine is the discipline concerned with the medical care of patients residing in Post-Acute, Long-Term Care, Rehabilitation and Assisted Living Facilities. The Physicians whose primary professional focus is the post-hospital medical care of these patients are called Post-Hospitalists.

<span class="mw-page-title-main">Gender discrimination in the medical profession</span> Gender discrimination against female clinicians within the health profession

Gender discrimination in health professions refers to the entire culture of bias against female clinicians, expressed verbally through derogatory and aggressive comments, lower pay and other forms of discriminatory actions from predominantly male peers. These women face difficulties in their work environment as a result of a largely male dominated positions of power within the medical field as well as initial biases presented in the hiring process, but not limited to promotions.

References

  1. ↑ Japsen, Bruce (December 17, 2021). "To Address Doctor Shortage, U.S. To Pay For 1,000 New Residencies". Forbes . Retrieved October 7, 2022.
  2. ↑ Reinhart, Eric (May 12, 2022). "The Blind Spot in Medicare for All". The Nation . Retrieved October 7, 2022.
  3. ↑ Carmichael, Mary (February 25, 2010). "Primary-Care Doctor Shortage Hurts Our Health". Newsweek . Retrieved October 7, 2022.
  4. ↑ "Number of Hospital-Employed Physicians Up 50% Since 2012 - staffing, human resources, physician, health system, cost - HealthLeaders Media". www.healthleadersmedia.com.
  5. ↑ "Archived copy" (PDF). Archived from the original (PDF) on 2017-01-20. Retrieved 2017-11-28.{{cite web}}: CS1 maint: archived copy as title (link)
  6. ↑ "$1 million mistake: Becoming a doctor". CBS News . 10 September 2013.
  7. ↑ "How many hours are in the average physician workweek?". 6 January 2015.
  8. 1 2 3 4 Aaron Young, PhD; Humayun J. Chaudhry, DO, MACP; Xiaomei Pei, PhD; Katie Arnhart, PhD; Michael Dugan, MBA; Scott A. Steingard, DO. "FSMB Census of Licensed Physicians in the United States, 2018" (PDF). Retrieved 2021-04-13.{{cite web}}: CS1 maint: multiple names: authors list (link)
  9. ↑ Aaron Young, PhD; Humayun J. Chaudhry, DO, MS; Xiaomei Pei, PhD; Katie Arnhart, PhD; Michael Dugan, MBA; and Gregory B. Snyder, MD. "FSMB Census of Licensed Physicians in the United States, 2016" (PDF). Retrieved 2021-04-13.{{cite web}}: CS1 maint: multiple names: authors list (link)
  10. ↑ "FSMB Census" . Retrieved 2021-04-13.
  11. ↑ Wachter R, Goldman L (1996). "The emerging role of "hospitalists" in the American health care system". New England Journal of Medicine. 335 (7): 514–7. doi:10.1056/NEJM199608153350713. PMID   8672160.
  12. ↑ Kuo, YF; Sharma, G; Freeman, JL; Goodwin, JS (2009). "Growth in the care of older patients by hospitalists in the United States". New England Journal of Medicine. 360 (11): 1102–1112. doi:10.1056/NEJMsa0802381. PMC   2977939 . PMID   19279342.
  13. ↑ Candeub, Adam (24 April 2020). "The American Board of Medical Specialties: Certification and The Need for Antitrust Enforcement" (PDF). aapsfoundation.org. AAPS. p. 4. Retrieved 13 April 2021. ...boards require periodic recertification every eight to ten years depending on the specialty
  14. ↑ Carolyn Y. Johnson (2021-11-24) [2016-06-08]. "This could be the real reason black doctors make less money than white doctors". The Washington Post . Washington, D.C. ISSN   0190-8286. OCLC   1330888409.[ please check these dates ]
  15. ↑ Ly, Dan P.; Seabury, Seth A.; Jena, Anupam B. (2016). "Differences in incomes of physicians in the United States by race and sex: Observational study". BMJ. 353: i2923. doi:10.1136/bmj.i2923. PMC   4897176 . PMID   27268490.
  16. ↑ Rimmer, Abi (2014). "Why do female doctors earn less money for doing the same job?". BMJ. 349: g5604. doi:10.1136/bmj.g5604. S2CID   57491609.
  17. ↑ "The Gender Pay Gap for Doctors is Getting Worse. Here's What Women Make Compared to Men". 10 April 2019.
  18. 1 2 "3 misconceptions about what drives medicine's gender pay gap". 18 December 2018.
  19. ↑ "Challenging gender bias in the house of medicine". 27 September 2018.
  20. ↑ "Physicians adopt plan to combat pay gap in medicine". 13 June 2018.
  21. ↑ "Cheers and jeers as med school's Step 1 test becomes pass/Fail". 14 February 2020.
  22. ↑ "21% of Physicians Furloughed, Had Pay Cut During COVID-19 Crisis". 28 April 2020.
  23. ↑ "1 in 5 physicians hit with pay cut or furlough due to COVID-19, survey says". 22 April 2020.
  24. 1 2 Rie Fujisawa; Gaetan Lafortune (2008). "OECD health working papers #41: The remuneration of general practitioners and specialists in 14 OECD countries: What are the factors influencing variations across countries?" (PDF). Directorate for Employment, Labour, and Social Affairs. OECD. p. 63. Retrieved 17 March 2013.
  25. 1 2 3 Laugesen, M. J.; Glied, S. A. (2011). "Higher Fees Paid to US Physicians Drive Higher Spending for Physician Services Compared to Other Countries". Health Affairs. 30 (9): 1647–1656. doi:10.1377/hlthaff.2010.0204. PMID   21900654.
  26. 1 2 3 4 5 "Medscape Physician Compensation Report: 2011". Medscape .
  27. ↑ "May 2022 National Occupational Employment and Wage Estimates". www.bls.gov. Retrieved 2023-06-22.
  28. ↑ Medline Plus (2012). "Doctor of medicine profession (MD)". U.S. National Library of Medicine of National Institutes of Health. Retrieved 20 December 2012.
  29. ↑ "Doctor of Osteopathic Medicine". U.S. National Library of Medicine of National Institutes of Health. 2012. Retrieved 20 December 2012.
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