Turning primary care on its head

I don't subscribe to The New England Journal of Medicine, but luckily for me a good number of the general interest articles are offered online for free. The November 13 issue includes several free perspectives on the future of primary care. There are interesting pieces about payment reform and the medical home but I was most intrigued by a detail in the perspective on Lessons from the U.K. by Martin Roland:

The United Kingdom takes the importance of primary care for granted. The U.K. government is effectively the country's single payer, and successive administrations have been convinced by mounting evidence that primary care promotes high-quality, cost-effective, and equitable health care. If anything, the U.K. government has become more convinced over the past 15 years that strong primary care needs to be at the heart of the country's health care system — quite the reverse of the situation in the United States. U.K. primary care physicians now have average earnings of $220,000 (in U.S. dollars), which is more than many specialists earn [emphasis mine]. The payment system is a mixture of risk-adjusted capitation and 25% additional pay for performance.

I've known for a while that primary care docs in the UK make as much or more on average than their US equivalents, but it always surprises people when I mention it. People simply assume that socialism necessarily means low wages, when at least in Europe it doesn't.I hadn't realized, though, that primary care docs are making more than specialists. Roland doesn't cite any evidence for this claim, but there are some interesting implications:

• Would medical students choose specialties with longer training requirements if they knew those specialties paid less?
• Is it just a matter of time before inflation in primary care income (as occurred with the introduction of pay for performance in the UK) translates into demands for higher pay by specialists?
• What would be the implications in the US of shifting power away from the AMA's Relative Value Scale Update Committee (RUC), which favors proceduralists over primary care? What if the American Academy of Family Physicians were placed in charge of this function and turned things upside down?