The Specialty Monopoly: Where Medicare Money Really Goes

Published February 2026 · 12 min read

The Big Five

Medicare covers 132 distinct specialties. But the spending distribution looks nothing like an even split. Internal Medicine, Ophthalmology, Clinical Laboratory, Family Practice, and Ambulance Services together absorb a third of every Medicare dollar spent.

This isn't necessarily surprising — these are high-volume specialties that serve the most patients. But the degree of concentration raises questions about where Medicare's priorities actually lie, and whether smaller specialties get squeezed.

The Outsized Money Problem

Some specialties punch far above their weight. Clinical Laboratory represents just 0.3% of all providers, but captures 6.7% of payments. Ophthalmology has just 1.6% of providers but receives 7.8% of all Medicare spending.

Compare that to Family Practice: 7.6% of providers, but only 5.2% of payments. The family doctor sees the most patients but gets the smallest slice of the pie per provider.

Highest-Paid Specialties Per Provider

Which specialties earn the most per provider? This reveals where the real money in Medicare is — not just total volume, but concentration of payments per practitioner.

Clinical laboratories lead at nearly $1.9 million per provider over 10 years — though these are mostly large corporations processing millions of tests. Radiation therapy centers, ambulatory surgical centers, and ophthalmologists round out the top spots.

At the bottom? Nurse practitioners average about $26,000 per year from Medicare. Physical therapists earn about $45,000. The specialty you choose determines your Medicare income more than almost any other factor.

The Policy Question

Medicare's specialty spending reflects decades of fee schedule decisions, lobbying, and historical precedent. Procedure-based specialties consistently earn more than cognitive specialties. A 15-minute eye injection can generate more revenue than an hour-long primary care visit.

This isn't just about fairness — it's about incentives. When Medicare pays ophthalmologists$383.7K per provider while family doctors earn $55.2K, medical students notice. The primary care shortage isn't just about workload — it's about money.