Although differences between the 2 bills on issues such as abortion, illegal immigrants, and how to finance healthcare reform capture the spotlight, physicians wonder how the blending process will affect their compensation.

One of the biggest pay issues involves Medicaid. Given how the combination state-federal program is notorious for grossly underpaying physicians, the House bill would gradually raise Medicaid rates to the level of Medicare rates at a cost of $57 billion. That increase is designed as an incentive for physicians to open their practices to the 15 million additional Americans expected to enroll in Medicaid during the next 10 years under both the House and Senate bills. The Senate bill, which has a lower price tag than its House counterpart, contains no Medicaid raise.

The number of physicians, administrators and allied health professionals employed by medical practices is expected to increase substantially from 2008 to 2018. Hospital employment will grow more slowly, according to Bureau of Labor Statistics projections.

What's unclear is where the physicians will come from to fill those positions, and how practices, given current payment trends, will be able to hire the number of staff the bureau projects will be required.

"The population is aging and growing, and, no matter how you're going to slice it, we're going to need more folks," said Mark Doescher, MD, MSPH, director of the WWAMI Rural Health Research Center at the University of Washington. "More and more care that used to be done on an acute short-stay hospitalization is now outpatient."

Experts are concerned that these projections will mean that current shortages of doctors and nurses will get worse.

"We have coming work force issues that are very real and that we are going to have to grapple with," said Dr. Doescher.

Part-time work is continuing to gain favor among physicians, with new studies showing that the trend is spreading to pediatricians. At the same time, more part-time positions are becoming available for ob-gyns in the academic setting.

Two surveys published online Dec. 14, 2009, in Pediatrics show that more pediatricians, including those nearing retirement age, are considering part-time work. And a study in the January Obstetrics & Gynecology found that growth in ob-gyn departments at U.S. medical schools in recent years has been accompanied by an increase in part-time faculty positions.

"It seems as though there is a growing acceptance of reduced hours of work within the [pediatrics] field," said William Cull, PhD, director of the Division of Health Services Research at the American Academy of Pediatrics and an author of the Pediatrics studies.