News Release

Earnings of physicians providing 'cognitive care' vs performing common specialty procedures

Peer-Reviewed Publication

JAMA Network

Medicare reimburses physicians three to five times more for common procedural care than for cognitive care (the main professional activities of primary care physicians), and these financial pressures may be a contributing factor to the U.S. health care system's emphasis on procedural care, according to a study by Christine A. Sinsky, M.D., of the Medical Associates Clinic P.C., Dubuque, I.A., and David C. Dugdale, M.D., of the University of Washington, Seattle.

The study compared the hourly revenue generated by a physician performing cognitive services and billing by time with that generated by physicians performing screening colonoscopy or cataract extraction for Medicare beneficiaries.

The revenue for physician time spent on two common procedures (colonoscopy and cataract extraction) was 368 percent and 486 percent, respectively, of the revenue for a similar amount of physician time spent on cognitive care, according to the study results.

"This value discrepancy is a major contributor to the decline in the number of physicians choosing primary care careers. Such a discrepancy may also contribute to an excess of expensive procedural care. We believe the strong financial incentives described compromise access to primary care and ultimately contribute to the lower quality and higher costs experienced in the United States compared with other developed countries," the study concludes.


(JAMA Intern Med. Published online August 12, 2013. doi:10.1001/jamainternmed.2013.9257. Available pre-embargo to the media at

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