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, the mean income for family physicians was $158,000 – very similar to what primary care physicians reported in the previous year. Almost one quarter of family physicians earned $100,000 or less; last year, 18% reported this mean income. About 12% of family physicians earned $250,000 or more. In 2010, about 12% earned that amount.
For employed family physicians, 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).
Four in 10 family physicians saw virtually no difference in income between 2011 and 2010. The same was true for physicians in all specialties.. More family physicians (38%) saw an increase in their earnings than saw a decline (22%). Last year, only 25% of family physicians saw an increase in income.
The gap in earnings between male and female family physicians has widened somewhat. Male physicians reported a mean compensation of $174,000 as compared with $134,000 mean earnings for women. The gap was smaller than in last year's survey. Overall, male physicians across all specialties earned 40% more than their female counterparts. Among family physicians, men earned 30% more. 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.
Family physicians earned the most in the North Central area (Iowa, Kansas, Missouri, Nebraska, and North and South Dakota), with a mean income of $185,000, which represents an increase over the previous year. The next-highest earners were doctors in the South Central region, with a mean income of $178,000. Family physicians in the Mid-Atlantic States earned the least: Their mean income was $142,000.
Family physicians in office-based multispecialty groups earned the most, at a mean income of $177,000 -- an increase over 2010. Those in single-specialty groups earned $160,000. Those in healthcare organizations and hospitals both earned $169,000. Family physicians in solo office practice earned $154,000.
Physicians across all specialties are nearly evenly split about whether they feel fairly compensated, with a bare majority (51%) saying yes. Among family physicians -- whose compensation is among the lowest of the specialties we surveyed -- 53% said they are unfairly compensated for their work. Primary care physicians were almost evenly split on this issue in the 2011 survey.
The vast majority of physicians don't consider themselves to be rich, and that's true for family physicians as well. Although the public may perceive most physicians as wealthy, only 9% of family physicians agree with that characterization. A majority (51%) said that their income is no better than that of many nonphysicians, while 40% said that they don't feel rich because of much debt and high expenses.
The largest percentage (39%) of family physicians spends 30-40 hours per week seeing patients; in 2010, about 40% reported the same amount of time. About 23% of family physicians spent less than 30 hours per week with patients (somewhat more than last year), while 5% reported spending more than 60 hours per week seeing patients.
The number of patient visits per week for family physicians has changed little since 2010. The largest proportion (22%) of family physicians has 76-99 patient visits per week, about the same as in the 2011 report. One fifth of family physicians has 50-75 visits per week, and 19% have 100-124 visits per week. About 11% have fewer than 25 visits per week (slightly more than last year), while 13% have at least 125 visits.
Almost one third (32%) of family physicians spends 13-16 minutes with each patient, and one quarter spends 17 to 20 minutes -- both about the same as in last year's survey. Only 3% of visits are less than 9 minutes long, whereas about 11% of family physicians conduct patient visits of 25 minutes or more.
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 and administrative tasks take up a significant portion of time for family physicians. A majority (53%) of these physicians spends 5-14 hours per week on paperwork and other non-patient-related activities -- slightly more than in last year's survey. About 11% spent 25 hours or more per week on these administrative chores, slightly more than in 2010.
Physician frustration is growing. The 2012 report shows far more dissatisfaction among doctors across all specialties. Still, nearly two thirds of family physicians would choose a career in medicine if they could do it all over again -- slightly less than in last year's report, but more than for physicians in all specialties (among whom only a little over one half would go into medicine again). In contrast, the satisfaction of family physicians with their specialty has declined sharply. In 2010, 44% of family physicians said they would choose the same specialty, whereas in 2011, only one third of respondents would do so. Similarly, one quarter of family physicians in the 2012 survey would choose the same practice setting, compared with close to one half in the 2011 survey.
Despite the interest in alternative patient-care delivery models, only a small percentage of family physicians are currently involved. About 5% participate in Accountable Care Organizations (ACOs), but 7% say they plan to do so in the coming year. Only 2% have concierge practices and 4% have cash-only practices, about the same as for physicians in all 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. About 44% of family physicians we surveyed believe that ACOs will cause a decline in income, while 14% say they will have little or no effect on income. About 42% 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. One third of family physicians said that these measures will lead to better patient care, compared with 25% of physicians across all specialties. About 38% of family physicians believe the guidelines and quality measures will have a negative effect, while 30% said that they will have no impact on the quality of patient care.
Almost 4 in 10 family physicians said that they have no intention of reducing the amount of tests, procedures, and treatments they perform because they believe that the quality guidelines and cost-containment measures aren't in patients' best interest. Almost one half (43%) of all physicians surveyed agree. Almost one quarter of family physicians said that they won't change their test and procedure recommendations because of the need to practice defensive medicine, almost the same as for all physicians. About 31% of family physicians said that they would reduce the number of tests and procedures because the guidelines are valid.
A majority (53%) of family physicians said they regularly discuss cost issues with patients, compared with 38% for all physicians. Another 39% of family physicians do so occasionally if patients raise the subject. Some 6% never discuss the issue because they themselves don't know the cost of the treatments, while 3% said they never discuss it because they don't believe it's appropriate to do so. In contrast, about 6% of all physicians believe these discussions are inappropriate.
Captions written by:
Mark Crane, Freelance writer, Brick, New Jersey
Mark Crane has disclosed no relevant financial relationships.
