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, cardiologists earned a mean income of $314,000, slightly down from the previous year. Still, cardiologists were among the highest earners in our survey, right behind radiologists and orthopedic surgeons (who were tied for the top position last year). About 16% of cardiologists earned $500,000 or more in 2011, down slightly from 20% in last year's survey. About 15% earn $100,000 or less.
For employed cardiologists, 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).
Four in 10 cardiologists said their income declined between 2010 and 2011. In last year's survey, one third experienced a decrease. For physicians in all specialties this year, 26% said their incomes were lower. Much of the decline in cardiologists' income is probably due to Medicare cuts in fees for procedures and imaging tests. More than one third of cardiologists said their income stayed the same, compared with close to 50% last year. One quarter of cardiologists said their income rose between 2010 and 2011.
The gap in earnings between male and female cardiologists has slightly narrowed. Male physicians reported mean compensation of $325,000, compared with mean earnings of $246,000 for women. Male cardiologists earn 32% more than women. Overall, male physicians across all specialties earn 40% more than their female counterparts. 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.
Cardiologists in the North Central region (Iowa, Missouri, Kansas, Nebraska, and South and North Dakota) earn the most, at a mean income of $379,000 -- a large decrease from the previous year. The next highest earners were cardiologists in the Northwest, at $369,000. Cardiologists earn the least in the West, at $270,000, and the Northeast ($271,000).
Cardiologists who are members of single-specialty group practices have the highest earnings, at a mean income of $388,000, followed by colleagues in multispecialty practices, at $327,000. Employees of healthcare organizations came in third, at $325,000, while office-based solo cardiologists earned $303,000. Hospital-based cardiologists and those in academia, government, or research earned considerably less.
The vast majority of physicians don't consider themselves to be rich, and that's true for cardiologists as well. Although the public may perceive most physicians as wealthy, only 13% of cardiologists agree with that characterization. One half of cardiologists said they don't feel rich because of so many debts and expenses, while 38% said their income is no better than that of many nonphysicians.
Cardiologists have a long workweek. Four in 10 cardiologists spend more than 50 hours per week seeing patients, slightly more than in last year's survey. Almost 20% spend 30-40 hours and 14% spend 41-45 hours per week. Only 11% spend less than 30 hours per week with patients, while 11% report spending more than 65 hours per week seeing patients, about the same as last year.
The highest percentage (25%) of cardiologists has between 50 and 75 patient visits per week, compared with about 18% one year ago. About 30% of cardiologists have fewer than 50 patient visits per week, the same as 1 year ago. Just over 1 in 4 cardiologists has 100-174 visits per week, and only 2% of respondents have more than 175 patient encounters per week.
About 31% of cardiologists spend 13-16 minutes with each patient, followed by 17-20 minutes (26%). Visits lasting 25 minutes or more were reported by 14% of respondents (18% last year). Only 4% of visits are less than 9 minutes long. The amount of time per patient visit excludes the patient's time with a nurse practitioner, physician assistant, or medical assistant; it measures only time spent in the presence of a physician.
Physician frustration is growing. The 2012 survey showed far more dissatisfaction among doctors across all specialties. Despite their high earnings, that's somewhat true for cardiologists as well. Although two thirds of these respondents told us last year that they would still choose a career in medicine if they could do it all over again, only 48% felt that way this year. One half of these doctors said they would choose the same specialty. Last year, 66% of cardiologists said they would do that. Only 18% said they would choose the same practice setting, compared with 45% a year ago.
Despite the interest in alternative patient-care delivery models, only a small percentage of cardiologists are currently involved. About 2% participate in Accountable Care Organizations (ACOs), but 9% say they plan to in the coming year. Only 1% have concierge practices and 1% have cash-only practices. Typically, such practices are more often found in primary care than in specialties.
An ACO is a 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. About two thirds of cardiologists we surveyed believe that ACOs will cause either a large or slight decline in income (compared with 46% of physicians in all specialties), while 6% say they will have little or no effect on income. About 30% said it's too soon to tell.
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 27% of cardiologists said these measures will lead to better patient care -- slightly higher than for physicians across all specialties. About 43% of cardiologists believe the guidelines and quality measures will have a negative effect, while 30% said they will have no impact on the quality of patient care.
Almost 4 in 10 cardiologists 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. Almost half (43%) of all physicians agree. Another 20% of cardiologists said that they won't change their routine because of the need to practice defensive medicine. About 32% of these doctors said that they would reduce the number of tests and procedures because the guidelines are valid. Another 9% would reduce tests and procedures because the guidelines will affect their income.
A majority (53%) of cardiologists said they occasionally discuss cost of care issues if patients raise the subject. About 46% of physicians overall said they do the same. Another 34% of cardiologists said they regularly discuss cost issues with patients, just less than the percentage for physicians in all specialties (38%). Some 7% of cardiologists said that they never discuss the issue because they themselves don't know the cost of the treatments, while 6% 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.
