www.medscape.

com

Physician Compensation: Doctors Adapting to a New Reality

Leslie Kane, MA

April 15, 2014

Changes in Healthcare Make an Impact

Medicine is undergoing significant changes -- some for the better and others less so. Compensation has increased slightly in 19 specialties; the income gap between men and women is narrowing; ACOs are making their impact felt; self-employed physicians earn more than employed ones; and cash-only practices, while still a tiny percentage of all practices, are gaining some traction. Those are some of the highlights of Medscape's Physician Compensation Report: 2014 Results. The report is based on an extensive survey of more than 24,000 US physicians representing 25 specialties.
Who's on Top?

Orthopedics ($413,000), cardiology ($351,000), urology ($348,000), gastroenterology ($348,000), and radiology ($340,000) are the 5 top-earning specialties, as they were in last year's survey. Radiology has moved down in rank a bit compared with our earlier surveys, and anesthesiology has been knocked out of the top five, where it ranked in earlier surveys.
Primary Care Income Has Gone Up Very Slightly

Compensation for both family physicians and internists is up 1% over last year. While physicians overall have been concerned about income declines due to healthcare reform, this was not the case in 2013 for 19 specialties which saw relatively modest increases. However, inflation in 2013 was 1.5%, so for many, income did not keep up with inflation. For primary care, some of the increase was probably due to the 10% bonus paid to primary care physicians who see Medicare patients, as stipulated in the Affordable Care Act. And despite the modest increase, family physicians and pediatricians are among the lowest-paid specialists, as they have been in our past surveys.
The Income Gap Between Male and Female Physicians Is Narrowing

Among physicians, men earn more than women, as they have in all past surveys. However, that picture appears to have improved. In 2010, male physicians earned 40% more than females, yet in 2013, males earned 30% more. Those percentages vary by specialty; in primary care, the disparity is smaller and it hasn't changed much. In 2013, among internists, men earned 13% more than women ($195,000 vs $173,000); in family medicine, men earned 19% more ($187,000 vs $157,000). Although men make more than women in almost every specialty, women tend to be as satisfied as men with their compensation or, in some specialties, even more satisfied. For example, female ob/gyns make $229,000 compared with $256,000 for men, but 47% of women are satisfied with their compensation compared with 38% of men. Female gastroenterologists make less than male gastroenterologists, but 55% are satisfied with their income vs 46% of men. In our survey, urology was the only specialty in which women made more than men (and female urologists were also more satisfied with their compensation).

Self-employed Physicians Earn More Than Employed Ones

Among physicians overall, self-employed doctors earned an average of $281,000 compared with employed physicians, who earned $228,000. In primary care, the difference was less pronounced; self-employed physicians earned $188,000 and employed physicians earned $180,000.
ACOs Are Clearly Making Their Impact Felt

In 2011, 8% of physicians were either in an Accountable Care Organization (ACO) or were planning to join one that year. In 2013, that percentage had risen to 34%. The growth in ACO participation year-over-year, according to Medscape surveys, has been steady: In 2013, almost a quarter of physicians (24%) who responded were already in ACOs and 10% planned on joining one this year; in our 2012 survey, only 8% of doctors were either in an ACO or were planning to join one.
Cash-Only Practices Seem to Be Becoming More Appealing

While still in the minority, the percentage of physicians involved in cash-only practices rose from 3% of respondents in 2011 to 6% in 2013. This is in line with physicians who are dissatisfied with payments and are looking for ways to practice that don't entail dealing with insurers.
Medicine as a Career Has Lost Some Appeal

Witness the answers to the following questions, comparing Medscape's 2011 report to the 2014 report: Would you choose medicine again? Yes (2011: 69%; 2014: 58%) Would you choose the same specialty? Yes (2011: 47%; 2014: 61%) Would you choose the same practice setting? Yes (2011: 50%; 2014: 26%)
Insurance Is a Huge Issue

When asked whether they were planning to participate in a health insurance exchange, more than a quarter of respondents (27%) said yes, another 20% said no, and more than half (53%) said they were not sure. Their caution probably has to do with fears about income; 43% of physicians said they expected their income to decrease if they participated in health insurances exchanges; 50% said they expected no change, and 7% said they expected their income to increase. In general, although a majority of doctors will continue taking new and current Medicare and Medicaid patients, about 25% haven't yet decided whether they will or won't, and a very small percentage (3% at most) will stop taking these patients. In regard to private insurance, 25% said they will drop insurers who pay poorly, while 39% will not.

Satisfaction With Compensation Has Not Changed Much in the Past 4 Years
In 2013, 50% of all physicians said they feel fairly compensated; 48% of primary care physicians feel fairly compensated. These figures are extremely close to the 2011 report percentages, in which 48% of all physicians said they felt fairly compensated and 51% of primary care physicians felt that way. The specialties that feel the most fairly compensated are dermatology (64%), emergency medicine (61%), pathology (59%), and psychiatry (59%). Family medicine (50%) and internal medicine (46%) score around the middle of the pack. Least satisfied with their compensation are plastic surgeons (37%), pulmonologists (39%), neurologists (41%), and endocrinologists (41%).
Ancillary Services Are Still Popular for Bringing in More Income

The specialties that most frequently offer ancillary services are orthopedics (33%), anesthesiology (31%), and gastroenterology (28%). In primary care, about 23% of family physicians and 20% of internists are offering ancillary services.
Discussing Treatment Costs With Patients Varies by Specialty

Cost is a huge factor in treating patients -- in some specialties more than others. Still, particularly in large health systems, treatment costs are most likely to be discussed with the billing staff rather than with the physician. Overall, in Medscape's 2014 survey report, 32% of physicians regularly discuss the cost of treatment with patients; 40% discuss it if the patient brings it up. Only 19% of surgeons regularly discuss the cost of procedures with patients, while 41% of ophthalmologists have this discussion regularly.
Paperwork Takes Up a Huge Chunk of Time

Not unexpectedly, self-employed doctors spend more time on paperwork than do employed doctors. About 29% of self-employed doctors say they spend from 1 to 4 hours on paperwork per week compared with 24% of employed doctors. And 31% of self-employed doctors say they spend 5 to 9 hours on paperwork vs 28% of employed doctors. One category in which employed physicians spend more time on paperwork vs self-employed physicians was 20 to 24 hours per week; 12% of employed doctors spend that amount of time compared with 6% of self-employed doctors It's likely that this situation relates to physicians who are in administration, academia, or perhaps are involved with clinical trials.
Time Spent With the Patient

The amount of time spent with the patient has not changed significantly in the past few years. Comparing 2010 and 2013: See patients for 13 to 16 minutes: 2010: 21%; 2013: 29% See patients for 9 to 12 minutes: 2010: 16%; 2013: 18% See patients for 17 to 20 minutes: 2010: 17%; 2013: 25% See patients for 25 minutes or more: 2010:15%; 2013: 13% Despite the frustrations, most physicians find their careers deeply rewarding. Being good at their jobs, having good relationships with patients, and making the world a better place were cited as key factors in making the practice of medicine worth the effort.

Medscape Business of Medicine 2014 WebMD, LLC

Cite this article: Physician Compensation: Doctors Adapting to a New Reality. Medscape . Apr 15, 2014.