THE IMPACT OF MANAGED CARE ON THE PHYSICIAN MARKETPLACE

Objective. To examine the impact of managed care on the employment and compensation of primary care and specialty physicians, as measured by changes in income, physician-to-population ratios, and specialty choi ces, Methods. The authors used data from the American Medical Associat ion's Socioeconomic Monitoring System survey, a nationally representat ive 1% random survey of post-residency patient-care physicians, and lo cation data from the AMA Masterfile to evaluate the relationship betwe en the growth in managed care from 1985 to 1993 and (a) inflation-adju sted physician incomes and (b) physician-to-population ratios for prim ary care physicians and specialists. They also used data from the Nati onal Residency Matching Program for 1989 through 1995 to look at trend s in available positions and specialty choices, Results. Primary care incomes grew 4.78% annually ($33,526 cumulatively) in states with the highest managed care growth, compared to 1.20% ($7448 cumulatively) in the lowest quartile of managed care growth, The difference in income growth for medical and surgical subspecialists between the highest and lowest quartiles was not statistically significant, The incomes of ra diologists, anesthesiologists, and pathologists (RAPs) rose 0.14%, or $1700, in the highest quartile versus 4.14% ($58,558) in the lowest, S ubspecialists per capita did not differ by quartile of managed care gr owth, but RAPs per capita increased fastest in states in the lowest qu artile. Between 1989 and 1995, the number of family practice and pedia tric residency positions that were filled rose 32%, while the number f illed remained stable for medical and surgical subspecialists and the number of RAP positions filed fell 14%. Conclusions. The growth in man aged care has been associated with significant changes in physician in comes and practice locations. Between 1985 and 1993, states with the f astest growth in managed care penetration saw the highest rate of grow th in primary care physicians' income and the slowest rate of growth i n RAP physicians' income. At the same time, the number of RAP physicia ns grew most rapidly in those states with the lowest rate of managed c are growth. Finally, between 1989 and 1995, there was a dramatic incre ase in the number of primary care residency positions filled and a mar ked decrease in the number of RAP residency positions filled across th e country.