Physician Compensation Report: 2013

Physician Compensation Report 2013

Income is up, frustration still exists, and healthcare reform is making a definite impact on physician practices. Doctors revealed the number of hours worked, changes to their practice, and satisfaction with their compensation and the practice of medicine.

Physician Compensation in 2012

By and large, physicians are still doing well and income is on the rise overall. About one third (8) of the specialties surveyed each earned a mean of over $300,000 annually. This year's 3 top-earning specialties -- orthopedics, cardiology, and radiology -- were the same as in Medscape's 2012 Compensation Report, although last year radiology and orthopedics tied for the number-one spot.

On the other side of the scale, HIV/ID dropped to bottom position this year, which was last year occupied by pediatrics.

For employed physicians, compensation includes salary, bonus, and profit-sharing contributions. For partners, compensation includes earnings after tax-deductible business expenses but before income tax. Compensation excludes non-patient-related activities (eg, expert witness fees, speaking engagements, and product sales).

Note: Totals in this slideshow may not add up to 100% due to rounding. "Not applicable" (N/A) responses were not included in the charts.

Who's Up, Who's Down Since 2011?

Most specialties reported income increases ranging from modest to significant. Orthopedic surgeons showed the highest increase, while endocrinologists and oncologists noted a slight decline.

"As the economy has gotten somewhat stronger, many people who have been putting off elective procedures are now getting them," says Tommy Bohannon, a vice president at Merritt Hawkins, a physician recruiting company in Irving, Texas. "As the population ages, more knees and hips are giving out and need to be fixed." As far as the 9% increase for internists and 5% increase for family medicine, "there's an intense doctor shortage, and healthcare reform is giving them a bit of a boost for Medicare patients," says Bohannon.

Do Men or Women Earn More?

There's still a large gap between male and female physicians, although that gap is narrower in primary care. Overall, male physicians earn 30% more than women; in primary care that gap is 17%.

One contributing factor involves choice of specialties. There are fewer women in some of the higher-paying specialties. For example, in orthopedics, only 9% of the survey respondents were women, whereas in pediatrics, 53% of survey respondents were women.

"As more doctors start working regular set hours for large health systems, there's little variance in income based on sex," Judy Aburmishan, partner in FGMK, LLC, a Chicago firm that represents physicians and other providers.

Physician Compensation by Geographical Area

Where you practice affects your income. This year, as in Medscape's previous two Compensation Reports, physicians in the North Central region earn the most ($259,000). The region comprises Iowa, Missouri, Kansas, Nebraska, South Dakota, and North Dakota. Also similar to prior years, physicians in the Northeast Region earn the least ($228,000).

"There's less managed care in the North Central region, fewer doctors, and a lower cost of doing business," says Tommy Bohannon. "The opposite is true in the Northeast.

Physician Compensation by Practice Setting

Physicians in group practices -- both single-specialty ($265,000) and multispecialty ($260,000) -- were among the top earners, which was similar to last year's survey results. Hospitals moved up as high payers; this year, physicians working in hospitals earned a mean of $260,000, compared with $225,000 in last year's report.

One change worth noting: In last year's report, physicians in solo practice earned more ($220,000) than did employed physicians ($194,000). Not so in this year's report: The income of solo practitioners ($216,000) has declined and is lower than that of employed physicians, who experienced an increase in income ($220,000).

Does Board Certification Matter to Income?

Although maintaining board certification can be time-consuming and costly, it's apparently quite worthwhile in terms of remuneration. Physicians with board certification earned significantly more than those without it.

In Medscape's 2013 report, 89% of overall respondents were board certified and 11% of respondents were not.

Do Physicians Feel Fairly Compensated?

That's a hot-button question, especially as physician payment methods are in the spotlight and potential future reimbursement declines threaten.

Nearly half of physicians (48%) do indeed feel that they are fairly compensated. But that figure signifies an erosion, declining from 51% in 2012 and 53% in 2011. Although the yearly change is small, it's clearly headed in one direction.

Surprisingly, with so much recent turmoil in primary care, satisfaction with compensation has gone in the opposite direction. In Medscape's 2011 report, 49% of primary care physicians said that they were satisfied with compensation. In the 2012 report, that figure was 46%, and this year's figure is the highest, at 51%.

Participation in Various Payment Models

There's a dramatic change in the number of physicians who are becoming involved in Accountable Care Organizations (ACOs). The focus on ACOs as a care-delivery and cost-containment method is making an impact.

In Medscape's 2012 report, only 8% of physicians were either in an ACO or planned to be in an ACO within a year. However, in 2013, 24% of respondents were either in an ACO or plan to be in one in the coming year.

The percentage of physicians in a concierge or cash-only practice increased very slightly from the previous year, from 4% to 6%.

Will You Stop Taking Medicare and/or Medicaid Patients?

Given the changes that will take place in Medicare reimbursement and the cuts to Medicare, many doctors are making some tough decisions about their Medicare patients. It's not being done lightly, however; only a minority of physicians plan to take the major step of no longer accepting or reducing their number of Medicare patients.

Overall, 9% of respondents plan to stop taking new Medicare patients but will continue caring for their current ones. A very small minority (2%) will no longer treat even their current Medicare patients.

Among internists, 11% will stop taking Medicare/Medicaid patients, and 15% of family physicians will make that same decision.

For a significant number of physicians, it's not a clear-cut decision; they've adopted a "wait and see" attitude, which could swing the results in either direction.

Will You Drop Insurers That Pay Poorly?

In line with potential reimbursement cuts, physicians are paying even more attention to their bottom line. Practice management experts advise reviewing one's payer panel each year and dropping the lowest-paying insurers. Apparently many physicians are planning to do just that: Close to a quarter (23%) of physicians will be dropping insurers who don't reimburse well.

Many physicians, though, feel that patients shouldn't be dropped merely because their insurers don't pay well. Almost a fifth (18%) of physicians say that dropping poor-paying insurers is not appropriate behavior, and 20% say that they need all payers.

Have You Started Offering New Ancillary Services?

Not only are physicians being more careful about payers, they're also looking for ways to bring in more revenue. In an effort to improve their bottom line, 19% of respondents have begun offering ancillary services to create more income opportunities for their practice.

"Many more physicians are offering ancillary services to add a cash type of payment to their practices," said Judy Aburmishan. The percentage adding ancillary services varies by specialty; for example, 30% of anesthesiologists say that they are adding ancillary services, compared with 17% for oncologists and 20% for internists.

Do You Discuss Cost of Treatment With Patients?

Cost is clearly a factor to be reckoned with in medical treatment. As high-deductible health plans become more prevalent, costs will become even more of an issue for many patients.

Our survey showed that 68% of physicians either regularly or occasionally discuss the cost of treatment with patients, compared with 84% last year. As more physicians become employed or work with hospitals or larger groups, in some cases the treatment costs may be discussed by the staff member responsible for billing and payment, rather than by the physician.

Hours Spent Seeing Patients per Week

The majority of physicians (66%) saw patients for up to 45 hours a week. Another 18% of doctors spent more than 50 hours a week seeing patients, including 9% of pediatricians, 22% of internists, and 11% of family physicians. Among orthopedists, the highest-earning specialty, 27% of respondents saw patients for more than 50 hours per week. On the other end of the scale, about 4% of dermatologists saw patients for more than 50 hours per week.

Number of Patient Visits per Week

More than a third (40%) of doctors see between 25 and 75 patients per week, very similar to findings in last year's report. Another 35% of respondents see between 50 and 99 patients per week, compared with 29% last year and 40% the year before.

The percentage of doctors who see a large number of patients has stayed fairly constant. In Medscape's 2012 and 2013 reports, about 25% of physicians see over 100 patients per week. Those seeing such a large volume of patients are likely working in a clinic or hospital setting.

Amount of Time Spent With Each Patient

Despite the fact that some situations encourage physicians to see a greater number of patients daily, doctors are still spending a meaningful amount of time with each of their patients. The largest group of doctors (30%) spends between 13 and 16 minutes per patient, and 21% spend between 17 and 20 minutes. In total, 51% spend between 13 and 20 minutes per patient. In Medscape's 2012 report, 47% spent between 13 and 20 minutes per patient.

The amount of time per patient excludes the patient's time with the nurse practitioner, physician assistant, or medical assistant; it measures only time spent in the presence of a physician.

Hours per Week Spent Seeing Patients in the Hospital

The amount of time spent in the hospital obviously varies by specialty. Overall, more than a fifth (22%) of respondents spent 25 hours or more seeing patients in the hospital.

Among internists, 29% spent 25 hours or more with hospitalized patients; that figure was 8% for oncologists, 24% for cardiologists, and 11% for obstetricians/gynecologists.

Hours Spent per Week on Paperwork and Administrative Work

Doctors are drowning in paperwork, whether it's actual paper or computer-based reporting. A lucky 20% of respondents have less than 5 hours of paperwork per week, but 51% of physicians spend from 5 to 14 hours per week on paperwork. Another 17% spend more than 20 hours per week on such tasks.

In Medscape's 2012 report, more than half of physicians (53%) spent under 5 hours on paperwork, and 23% spent from 5 to 14 hours.

Pathologists have among the most paperwork: Fully a quarter (25%) reported doing 25 hours or more of paperwork per week. Along the spectrum, 17% of endocrinologists spend 25 hours or more, while only 5% of urologists spend 25 hours or more on paperwork per week.

"Emerging reimbursement models are often based on how well you document what you did," said Tommy Bohannon. "It feels like more than half of compensation models have some qualifier relating to the accuracy and timeliness of documentation."

If You Had to Do It All Over Again, Would You...

Despite the frustration over reporting requirements, malpractice risks, EHRs, and other new aspects of medical practice, more than half of physicians would choose to become doctors again. While that's just slightly down from 54% in 2012, it's still a huge decline from the 2011 report in which a whopping 69% said they'd choose medicine again.

The specialties most apt to choose their own specialty again are dermatology (74%), ophthalmology (61%), and urology (60%). Least likely to choose their own specialty again are internists (19%), family physicians (28%), and obstetricians/gynecologists (37%). The dissatisfaction with their specialty, among primary care physicians, is palpable.

Satisfaction by Specialty

Overall satisfaction with one's medical practice seems to be stable from year to year.

In last year's report, the specialties that ranked highest in overall satisfaction were dermatology (64%), psychiatry (56%), emergency medicine (54%), HIV/ID (53%), and pathology (53%).

Those were nearly the same 5 specialties that topped the satisfaction scale in this year's report, although the percentages of those satisfied were somewhat down. Oncology moved up into the top 5 in terms of overall satisfaction.

In the 2013 report, dermatology again topped the list, at 59%, followed by HIV/ID and oncology (53% each). Pathology and psychiatry came in next at 52% each. Emergency medicine dropped to sixth place.

Satisfaction by Specialty (cont)

The specialties that showed the lowest overall satisfaction this year were similar to last year's ranking.

In last year's report, the least satisfied specialties were plastic surgery (41%), internal medicine (44%), and diabetes/endocrinology (45%). Five specialties tied for next place: Nephrology, urology, obstetrics/gynecology, neurology, and general surgery all showed 46% overall satisfaction with their practice of medicine.

Last year, 25% of internists said that they would choose the same specialty; this year it was 19%.

The Most Rewarding Part of Your Job

Whoever says that doctors choose their career for the money is just plain wrong. Although making a good income is clearly important to physicians, the relationship with patients and the intellectual challenge and satisfaction of being able to solve problems and make people better seems to be what it's all about.

Only a tiny minority (2%) felt that there was nothing whatsoever rewarding about being a physician.

Doctors described the most gratifying part of being a doctor: "Doing a good job in an honorable profession"; "Seeing people heal physically, emotionally, and spiritually"; "Knowing that I'm meeting a need and I'm good at what I do"; "I enjoy my patients, particularly the veterans of WWII"; "Helping indigent uninsured patients get care"; "Giving others hope."

Survey Respondents by Specialty

Total respondents: 21,878 US physicians across 25 specialty areas

Fieldwork conducted by Medscape, February 1-28, 2013

Data collected via third-party online survey collection site

For more information, see the following resources:

• Medscape Physician Lifestyle Report: 2013 Results
• Medscape's Best Places to Practice
• Medscape Physician Compensation Report: 2012 Results
• Medscape Physician Lifestyle Report: 2012 Results
• Medscape Ethics Report: 2012 Results
• More Slideshows