Medicare pay favors specialists.

Incomes vary widely among the four medical specialties--geriatrics, hematology-oncology, nephrology, and rheumatology--that derive more than half of their revenues from government-run health insurance programs, a study showed. For example, geriatricians' incomes averaged $165,000 annually, versus $504,000 for hematologists, even though the two specialties require a similar amount of training. The study, from Harvard Medical School researchers at Cambridge (Mass.) Health Alliance and published online in the Journal of General Internal Medicine, analyzed data from the national Medical Expenditure Panel Survey. The income disparity fuels the shortage of primary care physicians, lead author Dr. Karen Lasser said. "Debt-burdened medical students have much more lucrative career options," Dr. Lasser said in a statement. "What is surprising is that government fee schedules are behind much of this income discrepancy." In total, Medicare accounts for about 21% of payments to doctors, whereas Medicaid and other government programs account for 10%, according to the study.