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, endocrinologists earned a mean income of $168,000 – somewhat less than in the previous year, but still at the lower end of the earnings spectrum, along with primary care physicians and pediatricians. About 15% of these specialists earned more than $250,000, a lower percentage than in 2011; while 16% earned $100,000 or less -- about the same as in 2010.
For employed endocrinologists, 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).
About one third of endocrinologists reported that they earned more in 2011 than in 2010. One in 5 respondents said they earned less, while 48% said their compensation was the same. Those percentages were very close to those in Medscape's 2011 compensation report, where 45% of diabetes specialists and endocrinologists reported earnings similar to the previous year.
The gap in earnings between male and female physicians is narrower for endocrinologists than for physicians in all other specialties we surveyed. In this specialty, men earned 28% more than their female counterparts, which is almost exactly the same as in 2010. Across all specialties, male physicians earned about 40% more than female doctors. 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.
Endocrinologists earned the most in the Southeast (Alabama, Florida, Georgia, Kentucky, Louisiana, Mississippi, South Carolina, and Tennessee), at a mean income of $205,000. That's up from $197,000 in 2010, when that region was also number 1. The next-highest earners in 2011 were doctors in the North Central region, at a mean income of $190,000, followed by physicians in the Mid-Atlantic States, at $186,000. Physicians in the Northwest earned the least, at $130,000.
Endocrinologists in office-based single-specialty group practices earned the most, at a mean income of $188,000, followed by those in office-based multispecialty groups, at $179,000. In 2010, those in multispecialty groups earned significantly more. Diabetes specialists and endocrinologists in office-based solo practice earned about $163,000, while those who work at outpatient clinics earned the least -- a mean of $149,000.
Physicians across all specialties are nearly evenly split about whether they feel fairly compensated. However, those specializing in diabetes and endocrinology are at the lower end of the income range and feel more shortchanged than almost every other specialty -- 62% feel they are unfairly compensated for their work. Only plastic surgeons had the same level of dissatisfaction. In 2010, just over one half of endocrinologists (55%) said that they were unfairly compensated.
The vast majority of physicians don't consider themselves to be rich, and that's true for endocrinologists as well. Although the public may perceive most physicians as wealthy, only 9% of endocrinologists agree with that characterization. The rest are evenly divided between saying that they don't feel rich because of much debt and high expenses or because their income is no better than that of many nonphysicians.
About one third of endocrinologists spend an average of 30-40 hours per week seeing patients, which is almost identical to figures from 2010. About 24% of these physicians spend less than 30 hours per week with patients, compared with 19% last year. Last year, 3% worked over 60 hours per week; this year, 6% did so.
The highest percentage (24%) of diabetes specialists and endocrinologists sees 50-75 patients per week in both office and hospital settings, very similar to last year. About 12% of the respondents saw fewer than 25 patients per week, and only 2% see more than 200 patients per week -- about the same as last year in both instances.
The highest percentage of endocrinologists (29%) typically spends 17-20 minutes with each patient. Around 11% spend less than 12 minutes with each patient, about the same as in last year's survey. Finally, about 20% of the respondents spend 25 minutes or more; in last year's report, about 25% had such lengthy patient visits.
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.
Paperwork, participation in professional organizations, clinical reading, and supervisory and administrative work take up a significant amount of time for diabetes specialists and endocrinologists. About 3 in 10 of these specialists (29%) spend 10-14 hours per week on these tasks; this was nearly identical to the prior year's results. Some 15% spend 25 or more hours per week on non-patient-related activity. In contrast, less than 10% spent that much time on these types of administrative chores in 2010.
Physician frustration is growing. The 2012 report shows far more dissatisfaction among doctors across all specialties. That's especially true for endocrinologists. While nearly 70% told Medscape in 2011 that they would choose a career in medicine if they could do it all over again, only 57% feel the same way in 2012. For physicians in all specialties, just over one half would go into medicine again. However, only 38% of endocrinologists would choose the same specialty again; this is a large decline from 2011, when almost 70% said they would again opt for a career in endocrinology. Only 19% would choose the same practice setting, compared with nearly 53% who said they'd do that in 2011.
Despite the interest in alternative patient-care delivery models, only a small percentage of endocrinologists are currently involved. About 4% participate in Accountable Care Organizations (ACOs), but 5% say they plan to do so in the coming year. Less than 1% have concierge practices, and 2% have cash-only practices. Typically, such practices are more often found in primary care than in specialties.
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. A majority of diabetes specialists and endocrinologists (51%) believes that ACOs will cause a decline in income, while 11% say that they will have little or no effect on income. About 38% of these specialists said it's too soon to tell.
Some elements of healthcare reform entail following treatment and quality guidelines set by insurers and Medicare for shared savings programs. Physicians across all specialties are clearly skeptical that they will improve patients' quality of care. Only 16% of diabetes specialists and endocrinologists said that these measures will lead to better patient care, compared with 25% of physicians in all specialties. Nearly one half of diabetes specialists and endocrinologists believe the measures will have a negative effect, compared with 47% of all physicians. Just over one third of diabetes specialists and endocrinologists said the guidelines will have no impact on the quality of patient care (vs 29% of all physicians).
Two thirds of endocrinologists said that they have no intention of reducing the amount of tests, procedures, and treatments they perform on the basis of goals for quality guidelines and cost-containment or cost-effective treatment. A large majority (67%) of physicians in all specialties said the same. A majority of endocrinologists said the guidelines aren't in their patients' best interest; 43% of all doctors surveyed said the same. About 15% of endocrinologists said they still need to practice defensive medicine, no matter what the guidelines. One quarter of these specialists said they would reduce the number of tests and procedures because the guidelines are valid (compared with about 27% of all physicians).
Almost one half of the endocrinologists we surveyed said they regularly discuss the cost of treatment with patients. Among physicians in all specialties, just over one third regularly has such discussions. Another 46% of diabetes specialists and endocrinologists said that they discuss cost issues occasionally if the patient raises the subject -- about the same as for all physicians. About 6% of said they never discuss the issue because they themselves don't know the cost of the treatments or don't believe it's appropriate, while this is true for 14% of all physician respondents.
Captions written by:
Mark Crane, Freelance writer, Brick, New Jersey
Mark Crane has disclosed no relevant financial relationships.
