It may be common knowledge that doctors’ pay outstrips average wages, with the really high earnings going to medical specialists. But now, more and more doctors are becoming specialised, with implications for costs and healthcare policy more generally. There were some 3.2 million doctors in the OECD area in 2008, which is over 40% more than in 1990 in absolute terms. But looked at on a per head basis, the number of specialists expanded by about 50% over the same 18 year period, compared with a mere 15% rise per capita for GPs.
As a result, the number of medical specialists now exceeds generalists in all but four OECD countries–Australia, France, Korea and Portugal. This trend towards specialisation may reflect advancements in medical technologies and the increasing complexity of healthcare. But it also reflects a a widening pay gap.
Indeed, despite the sharp rise in the number of specialists, their pay has grown faster than that of generalists in a diverse group of OECD countries, includingAustralia, Finland, Hungary and the Netherlands . Only in a few European countries, such as Belgium and Luxembourg, has the income of generalists grown faster than that of specialists.
Having more specialists is clearly not bad in itself, but a shift away from GPs can undermine primary care and increase costs pressures.
The UK is one country that has taken deliberate steps to improve the relative attractiveness of general practice . New contracts were introduced in 2004, and since then GP pay has risen sharply. Whether the extra cost incurred in improving the GP contracts has delivered value for money is less clear. But the search for policies to encourage a more effective GP/specialist balance is set to continue.