Leslie Kane, MA
Executive Editor
Medscape Business of Medicine
Disclosure: Leslie Kane, MA, has disclosed no relevant financial relationships.
Compare Compensation Across 25 Specialties
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In 2011, anesthesiologists earned a mean income of $309,000, down from $325,000 the prior year. These respondents are among the top 6 fields in earnings, at more than $300,000. The others are radiology, orthopedic surgery, cardiology, and urology. About 7% of anesthesiologists earn $500,000 or more. About 10% earn $100,000 or less, compared with 6% in last year's survey.
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).
Just over 4 in 10 anesthesiologists saw virtually no difference in income between 2011 and 2010, about the same as for physicians in all specialties. Another 34% of anesthesiologists saw a decrease in their earnings (compared with 16% last year), while 26% reported an increase (compared with about 20% last year). In last year's survey, about one half of anesthesiologists saw no change
The gap in earnings between male and female anesthesiologists has slightly widened. Males reported mean compensation of $324,000, compared with $260,000 mean earnings for women. In last year's survey, the gap was slightly smaller. Overall, male physicians across all specialties earn 40% more than their female counterparts. For anesthesiologists, the gap is 25% (compared with 18% last year). According to Tommy Bohannon, divisional vice president of Merritt Hawkins (a physician recruitment firm), more female physicians work part-time, which contributes to an overall lower income.
Anesthesiologists in the South Central region (Texas, Oklahoma, and Arkansas) earn the most, at a mean income of $331,000 – a slight increase over the prior year. The next highest earners were physicians in the Great Lakes region, at $328,000. Last year, anesthesiologists in the Southwest earned the most. Respondents in the West earned the least, at a mean income of $283,000. For physicians overall, those in the North Central states earned the most.
As in last year's survey, anesthesiologists who are members of multispecialty group practices have the highest earnings, at a mean income of $396,000 -- somewhat higher than last year. Anesthesiologists in single-specialty groups came in second, at a mean income of $346,000, which was about the same as last year. Anesthesiologists in solo practice; outpatient clinic practice; and academia, research, or government earn the least.
Anesthesiologists are generally happier with their lot than physicians overall. Physicians across all specialties are nearly evenly split about whether they feel fairly compensated. Some 59% of anesthesiologists said they are fairly compensated. Last year, 63% felt that way. Although anesthesiologists are among the highest-earning physicians, 4 in 10 said they are unfairly compensated.
The vast majority of physicians don't consider themselves to be rich, and that's true for anesthesiologists as well. Although the public may perceive most physicians as wealthy, only 11% of anesthesiologists agree with that characterization. More than one half of these respondents said they don't feel rich because of so many debts and expenses, while 34% said their income is no better than that of many nonphysicians.
The largest percentage (21%) of anesthesiologists spends 46-50 hours per week seeing patients -- in the operating room, the recovery room, the intensive care unit, and other clinical settings. In last year's survey, only 15% of anesthesiologists spent this amount of time with patients. About 16% of anesthesiologists spend 30-40 hours per week with patients. About 16% spend from 56-60 hours per week with patients, while more than 11% report spending more than 60 hours per week seeing patients.
About a third (36%) of anesthesiologists have 25-49 patient encounters per week -- slightly less than in last year's survey. Some 28% of respondents see fewer than 25 patients per week, about the same as last year. Weekly patient loads in excess of 100 patients are rare in anesthesiology: Only 9% of respondents see that number of patients.
Compared with most other physicians, anesthesiologists have considerably less paperwork and administrative responsibilities. About one third of anesthesiologists spend 4 hours or less per week on these tasks, while 32% spend between 5-9 hours on them. In contrast, 44% of physicians in all specialties spend less than 9 hours on these chores. Only 7% of anesthesiologists spend more than 20 hours per week on them, compared with 18% for physicians overall.
Physician frustration is growing. The 2012 survey showed far more dissatisfaction among doctors across all specialties. Despite their high earnings, that's true for anesthesiologists as well. Although 61% of anesthesiologists told us last year that they would still choose a career in medicine if they could do it all over again, only 46% felt that way this year. Some 45% would choose the same specialty again, compared with 70% in last year's survey. Only 1 in 5 anesthesiologists said they would choose the same practice setting, compared with 53% last year.
Despite the interest in alternative patient-care delivery models, only a small percentage of anesthesiologists are currently involved. About 2% participate in Accountable Care Organizations (ACOs), but 4% say they plan to in the coming year. Only 2% have cash-only practices; typically, such practices are found more in primary care than in specialties.
Elements of healthcare reform entail following treatment and quality guidelines set by insurers and Medicare for shared savings programs, but physicians are clearly skeptical that they will improve patients' quality of care. About 15% of anesthesiologists said these measures will lead to better patient care; for physicians in all specialties, about 22% feel the same. A majority (53%) of anesthesiologists believe the guidelines and quality measures will have a negative effect, while 31% said they will have no impact on the quality of patient care.
An ACO is a type of payment and delivery model that ties provider reimbursement to quality metrics and reduction in the total cost of care for an assigned patient population. An ACO may initiate bundling of payments for various clinical outcomes. Two thirds of anesthesiologists we surveyed believe that ACOs will cause either a large or slight decline in income (compared with 46% of physicians in all specialties), while only 6% say they will have little or no effect on income. About 29% said it's too soon to tell.
More than 4 in 10 anesthesiologists we surveyed said that they have no intention of reducing the amount of tests, procedures, and treatments they perform because they believe the quality guidelines and cost-containment measures aren't in patients' best interests. One third of all physicians agree. Another 27% of anesthesiologists said that they won't change their test and procedure recommendations because of the need to practice defensive medicine. About 21% of these doctors said that they would reduce the number of tests and procedures because the guidelines are valid. Another 7% would reduce tests and procedures because the guidelines will affect their income.
Almost one half of anesthesiologists said they occasionally discuss cost of care issues if patients raise the subject. About 42% of physicians overall said they do the same. Only 16% of anesthesiologists said that they regularly discuss cost issues with patients; typically, the situation of preparing for surgery does not lend itself to having such discussions. Approximately 1 in 5 anesthesiologists said they never discuss the issue because they themselves don't know the cost of the treatments, while 18% said they never discuss it because they don't believe it's appropriate to do so.
Captions written by:
Mark Crane, Freelance writer, Brick, New Jersey
Disclosure: Mark Crane has disclosed no relevant financial relationships.
