Physician Earnings: Modest Increase but Frustration Remains

Carol Peckham

Disclosures

April 21, 2015

In This Article

Physicians and Career Satisfaction: It's Not the Money

If I Had to Do It All Over...

In the 2011 Medscape report, 69% of physicians said they would choose medicine as a career again and 61% would select their own specialty. This year, 64% would still choose medicine, but only 45% would select their own specialty. Furthermore, in 2011, half said they would choose their own practice setting, but this year only about a quarter (24%) would go that same route.

When looking at all specialties, 73% of family physicians, 72% of rheumatologists, and 71% of internists would choose medicine again as a career. In last year's survey, internists and family physicians were also within the top three spots, but fewer reported that they would choose medicine again (68% and 67%) than they did this year. The least likely to choose medicine again were radiologists (49%), orthopedists (50%), and plastic surgeons (51%).

Although only 54% of dermatologists said they would choose medicine again, if they did, about three quarters (74%) would choose their own specialty. In second place, about two thirds (66%) of orthopedists would choose their own specialty, although only half of them said they would be physicians again. And at the bottom of the list, only 25% of internists and 31% of family physicians would want to be primary care doctors again, but both groups were within the top three of re-choosing medicine as a career.

To determine the level of general career satisfaction, Medscape averaged the percentage of physicians who again would choose medicine, those who again would choose their specialty, and those who thought they were fairly compensated. According to the calculation, the most satisfied physicians this year are dermatologists (63%), followed by pathologists, psychiatrists, and emergency medicine physicians (all at 57%). The least satisfied, from the bottom up, are internists (47%) and then nephrologists and general surgeons (48% and 49%, respectively).

If Money Isn't the Cause of Dissatisfaction, What Is?

Women and men reported slight differences in what they found most rewarding about their jobs. About a third of both (32% of women and 34% of men) cited being very good at their job as a reward, and more women (37%) than men (32%) believe that relationships with patients are a major source of satisfaction. Making good money is far down the list of rewards; 8% of women and 11% of men considered this a benefit.

It is interesting that compensation levels do not appear to play a significant role in whether physicians would choose their profession again. The specialists most likely to choose medicine again are not necessarily the highest paid, nor are those least likely always the lowest paid. Nor does the degree to which physicians feel satisfied or dissatisfied with their compensation seem to correlate with how much they make. About the same percentage of PCPs (47%) and specialists (50%) believe that they are fairly compensated.

In a 2012 Medscape Primary Care Roundtable on burnout,[17] Robert Centor, MD, expressed an opinion that much of physician burnout is due to the payment systems—not income itself: "Too often the current finances of medicine 'force' physicians to spend inadequate time with patients. Regarding the point, administrators often encourage this behavior. Too many administrators have examined overhead and income, and their analysis argues that physicians should spend less time with each patient. I would argue that our payment system, especially for outpatient internists and family physicians, is a leading cause of burnout."

A presentation on primary care by the Robert Graham Center offered the following quote on the conflicts that the various payment models are causing: "When providers are paid a salary they provide little care for few; when capitated they provide little care for as many as possible; when paid for performance they provide as much care as possible for the stuff being measured; and when fee for service they provide as much care as possible for as many as possible."[18]

The 2015 RAND report[11] reinforced Dr Centor's view in its conclusion on new payment models, which have increased the intensity of both clinical and nonclinical work. New nonclinical work associated with many of these alternative models was particularly despised if physicians were unable to find any association with improved patient care. "Overall, increased stress on physicians might directly harm the quality of patient care and might also serve as a marker that physicians are concerned about the quality of care they are able to provide."

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