Getting the balance right between generalism and specialisation: does remuneration matter?

Background: Remuneration has been cited as a factor influencing the distribution of doctors between generalist and specialist roles. Objective: To review the evidence on earnings differentials between specialists and GPs, and suggest possible policy responses. Discussion: Specialists earn almost twice as much as GPs but only half of this difference can be explained by differences in their characteristics. Evidence suggests that expected future earnings, together with a range of other factors, influence specialty choice. Directly altering relative earnings may be difficult, but greater targeted investment in primary care is more achievable to help shift the balance.