Leslie Kane, MA
Editorial Director
Medscape Business of Medicine
Saturday, June 10, 2023
Leslie Kane, MA
Editorial Director
Medscape Business of Medicine
• Survey fielded to 455,000 U.S. physicians
• Total respondents*: 15,794 U.S. physicians across 22 specialty areas
• Fieldwork conducted by Medscape from 2/2/11 to 3/30/11
• Data collected via third-party online survey collection site
*Respondents were entered into a sweepstakes to win a $50 American Express gift card - issued to 100 physicians. Demographic/attitudinal weighting not applied to tabulation
A median annual salary of $325,000 makes anesthesiology among the most highly paid specialties among respondents to Medscape's survey. Only radiologists, orthopedic surgeons, and cardiologists earned this much or more. Twenty percent of respondents earned $300,000 to $349,000, and 25% earned $350,000 to $449,000. The highest earners among anesthesiologists are subspecialists, particularly those who focus on pediatrics and cardiology.
"Most anesthesiologists are salaried," says an anesthesiologist in New York. "However, for most private practice doctors, their paycheck may not truly represent what they actually take home. For example, they can put more money into a retirement plan, such as a defined benefit plan, so they can defer the income and the high taxes."
One anesthesiologist from New Jersey commented, "There is not much negotiating room with managed care and insurance companies, which always try to ratchet down their payments. Also, the big multistate provider groups have been reducing salaries."
For employed anesthesiologists compensation covers 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 services, speaking engagements, and product sales).
The recession and declining reimbursements from major insurers has affected anesthesiologists; however, in line with most other physicians, 49% of anesthesiologists earned the same in 2010 as they did in 2009 and 28% earned less. The percentage of anesthesiologists whose income declined by one tenth -- 16% -- was exceeded only by urologists (17%) and radiologists (18%). As the same time, average increases in income for anesthesiologists were slightly lower than those for physicians as a whole. One reason that earnings have not declined even more is that anesthesiologists whose reimbursements were cut took on more cases, administrative responsibilities, and other duties, says an anesthesiologist in California.
Although increasing numbers of women are entering the medical profession, men continue to be the biggest earners, in part because women are more likely to accept less pay in exchange for more flexible, family-friendly schedules. Among respondents as a whole, median earnings for male doctors ($225,000) exceeded median earnings for female doctors ($160,000). The pay gap between male and female anesthesiologists was somewhat narrower: men's reported median compensation of $335,000 was 18% higher than women's median compensation of $275,000.
Anesthesiologists' income does not vary dramatically from region to region, according to survey respondents. The lowest median compensation is earned by anesthesiologists who practice in the Southwest, and the highest income group is in the Southeast.
"In the Southeast, there is a high percentage of nurse-anesthetists; MDs can bill more money," says one anesthesiologist. "If doctors are supervising 3 or 4 nurse-anesthetists, which may increase their earnings, this may be why doctors in the Southeast earn more."
The more populated the locale, the lower anesthesiologists' median pay. In small towns and rural areas, home to under 10% of the anesthesiologist respondents to this survey, median income is $365,000 -- more than the median earnings of their colleagues in major metropolitan areas and the suburbs.
Overall, it's likely that more doctors are needed in rural areas, so physicians in these regions can command higher pay, says one anesthesiologist.
Anesthesiologists who are partners in a private practice draw the highest median compensation, followed by those who are self-employed or are members of group practices. Outpatient clinics, academia, and the military are less high-paying, but anesthesiologists in those settings still typically command salaries in the range of $250,000 to more than $300,000. Pay in academia often comes via pursuits other than patient care, including research, teaching, and administrative duties.
Anesthesiologists in private practice are somewhat more likely than employed anesthesiologists to feel that they are being paid fairly. In the profession overall, because anesthesiologists earn more than most physicians, it's not surprising that 63% of physicians in this specialty say they are satisfied with their earnings. Indeed, the only other specialties more satisfied with their earnings are dermatologists (71%), emergency medicine physicians (65%) and radiologists (69%).
As one respondent notes, "Anesthesiology pays well. We don't have to deal with the insurance issues. We don't have the after-work responsibility. There is not much need for patient follow-up."
Increasing numbers of anesthesiologists are becoming financial and clinical players in ambulatory care settings. Although 83% of anesthesiologists have yet to invest in an ambulatory surgery center, some 11% have done so -- about 2% more than respondents overall-- and about 5% of anesthesiologists expect to invest in a clinical procedure facility in the near future.
One anesthesiologist notes, "People who can own ASCs [ambulatory surgery centers] can collect on their professional fees as well as get income from the facility fees. Many ASC owners try to employ anesthesiologists and others, bill and collect for their services, and then pay them below-market rates -- a controversial practice that is being challenged in some places."
Anesthesiologists who responded to Medscape's survey typically spend upward of 40 hours per week seeing patients -- in the operating room, the recovery room, the intensive care unit, and other clinical settings. As many as one in 10 anesthesiologists are with patients more than 65 hours weekly. Because anesthesiologists tend to work full-time rather than part-time, only 8% of respondents said that they see patients fewer than 30 hours per week, and 15% see patients 30-40 hours per week.
As one anesthesiologist notes, "Anesthesiology is an area where work hours are variable depending on the scheduling of other specialties, ie, emergencies, surgeries, and so forth." There are few notable variations in the number of hours that employed and private practice anesthesiologists spend with patients per week. In general, the median hours worked by employed anesthesiologists and those in private practice were similar. However, at the high end of the scale, private practice anesthesiologists were slightly more likely than employed practitioners to spend more than 65 hours per week with patients.
Because anesthesiologists typically spend considerable time with each patient, slightly more than 25% see fewer than 25 patients weekly. Almost 40% see 25-49 patients weekly, and another 17% see 50-75 patients. Weekly patient loads in excess of 75 are rare in anesthesiology.
"Anesthesiologists doing pain management might see many patients a week, since they deal with mostly ambulatory patients and might perform blocks and other short procedures on them," notes one anesthesiologist from New Jersey.
One half of anesthesiologist respondents spend from 5 to 14 hours on non-patient-care activities, including paperwork, participation in professional organizations, clinical reading, supervisory work, and administrative/managerial work. Compared with most other physicians, however, anesthesiologists do not have much in the way of paperwork responsibilities.
Only 61% of anesthesiologists say that they would choose a medical career if they had the chance to do it again -- the lowest percentage in the survey. On the other hand, of those anesthesiologists who would choose medicine again, 70% would pick the same specialty; this proportion is much greater than that for primary care physicians, OB/GYNs, and many others. Of note, anesthesiology is ranked 11th in CNNMoney.com's list of the 50 best jobs in America -- the highest ranking for a medical specialty. The CNN raters acknowledged that anesthesiology is a high-stress profession, but the specialty nonetheless garnered "A" grades for personal satisfaction, future growth, and benefit to society.
Business, engineering, and finance were anesthesiologists' most preferred alternative career choices. "Doctors do watch trends and successful companies and sometimes wonder if they could have been an effective CEO," says one anesthesiologist. "It could be that doctors are more business-oriented than in the past, and are more actively engaged and interested in business issues relevant to the practice of medicine."
Respondents chose the legal profession, radiology, computer science, architecture, or aviation. Dentistry and investment banking each garnered some votes. A wide range of other professions -- from "anything but medicine!" to weatherman -- were mentioned by respondents. A respondent who would become a nurse-anesthetist wrote, "Same fun job, but without as much stress and without the decade of training to get here." Another regretted not becoming an investment banker working for Goldman Sachs.
Anesthesiology remains a male-dominated profession; not quite 23% of respondents were women. However, this percentage may change now that 40% of anesthesiology residents are women.
"Now, it seems more females tend to join this specialty because anesthesia technique has improved tremendously; it definitely allows for a better lifestyle now," says a female anesthesiologist.
The survey's collection timeline spanned from February 2, 2011, through February 17, 2011. Demographic/attitudinal weighting was not applied to tabulation as the survey was sent to physicians with a similar demographic profile. In some cases, small sample size may skew data results. However, the overall number of responses by specialty mirror AMA breakdown. Note that compensation data is represented by the median reported figures.
