The income gap: specialties vs primary care or procedural vs nonprocedural specialties?

The gap in median income between primary care physicians and specialists is well-publicized. Health care policy discourse that focused on this gap currently pits primary care physicians against all specialists. However, a number of specialists are also nonprocedural in that they derive the bulk of their income from evaluation and management. Nonprocedural specialties are experiencing the same economic disadvantages as primary care, with the resulting difficulty in attracting graduating US medical school seniors into the specialty. This predicts notable future workforce shortages unless there is a fundamental change in the financial incentives. There are strong financial incentives to focus on procedures rather than patient-centered care. To assure the availability of a balanced physician workforce, the availability of a full spectrum of expertise, and access of patients with chronic conditions to the appropriate physicians, health care financing must change the misaligned financial incentives and meaningfully close the income gap for both primary care and nonprocedural specialties.