Leslie Kane, MA
Executive Editor,
Medscape Business of Medicine
Disclosure: Leslie Kane, MA, has disclosed no relevant financial relationships.
Compare Compensation Across 25 Specialties
How Are You Coping with Income Changes? Join the discussion.
In 2011, gastroenterologists earned a mean income of $303,000 -- slightly more than in the previous year. They are among the top 6 specialists in annual earnings, at more than $300,000. The other 5 top-earning specialties are radiology, orthopedic surgery, cardiology, anesthesiology, and urology. About 15% of gastroenterologists earned $500,000 or more. Some 13% earned $100,000 or less, the same as in last year's report.
For employed gastroenterologists, 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 gastroenterologists saw virtually no difference in income between 2011 and 2010; the same was true for physicians in all specialties. In Medscape's 2011 report, about one half of gastroenterologists saw no change in their income. Another 32% of these respondents saw a decrease in their earnings (compared with 26% last year), while 28% reported an increase (compared with 21% last year).
The gap in earnings between male and female gastroenterologists has narrowed. Male gastroenterologists reported a mean compensation of $315,000 as compared with $249,000 mean earnings for women. Overall, male physicians across all specialties earned 40% more than their female counterparts. For gastroenterologists, the gap is 27%. 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.
As in the 2011 report, gastroenterologists in single-specialty group practices have the highest earnings, with a mean income of $409,000 -- slightly higher than in last year's survey. Employees of healthcare organizations came in second, at $344,000. Office-based gastroenterologists in solo practice were third highest, at $323,000 -- higher than in last year's survey. Hospital-based gastroenterologists had considerably lower earnings of those in single-specialty group practices.
Physicians across all specialties are nearly evenly split about whether they feel fairly compensated. The same is true of gastroenterologists. Although these respondents are among the more highly-paid physicians, only a bare majority (51%) said they are fairly compensated for their work -- the same percentage as for physicians overall.
The vast majority of physicians don't consider themselves to be rich, and that's true for gastroenterologists as well. Although the public may perceive most physicians as wealthy, only 14% of gastroenterologists agree with that characterization. One half of these respondents said that they don't feel rich because of much debt and high expenses, while 37% said that their income is no better than that of many nonphysicians.
The largest percentage (23%) of gastroenterologists spends 30-40 hours per week seeing patients. The second largest percentage (20%) spends 41-45 hours, followed by 18% who see patients 46-50 hours per week. About 14% of gastroenterologists spend less than 30 hours per week with patients, and 6% reported spending more than 60 hours per week. In last year's report, about 13% of gastroenterologists reported seeing patients for more than 60 hours per week.
The highest percentage (24%) of gastroenterologists has 50-75 patient visits per week, about the same as in last year's survey. Just under 1 in 5 gastroenterologists has 100-174 visits per week. About 10% have fewer than 25 visits -- up from 7% in last year's survey -- while just 1% have more than 175 visits.
About 27% of gastroenterologists spend 17-20 minutes with each patient, and 23% spend 13-16 minutes. Visits lasting 25 minutes or more were reported by 15% of respondents. Only 2% of visits are less than 9 minutes long, about the same as last year's report.
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.
Almost one third of gastroenterologists spend 10-14 hours per week on paperwork and administrative tasks, a slightly higher percentage than last year. Another 29% spend 5-9 hours. About 14% of gastroenterologists spend at least 20 hours per week on administrative chores -- slightly more than in last year's survey.
Physician frustration is growing. The 2012 report shows far more dissatisfaction among doctors across all specialties. Whereas 76% of gastroenterologists told us last year that they would still choose a career in medicine if they could do it all over again, only 58% felt that way this year. Only 51% of gastroenterologists said they would choose the same specialty, compared with 80% last year. Less than one quarter would choose the same practice setting.
Despite the interest in alternative patient-care delivery models, only a small percentage of gastroenterologists are currently involved. About 2% participate in Accountable Care Organizations (ACOs), but 9% say they plan to do so 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 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. Six in 10 gastroenterologists we surveyed believe that ACOs will cause either a large or slight decline in income (compared with 52% of physicians in all specialties), while 8% say that they will have little or no effect on income. About 31% said that 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 22% of gastroenterologists said that these measures will lead to better patient care – a slightly lower percentage than for physicians across all specialties. About 48% of gastroenterologists 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.
Four in 10 gastroenterologists 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 half (43%) of all physicians agree. Another 29% of gastroenterologists said that they won't change their routine because they still need to practice defensive medicine. About 23% 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 (54%) of gastroenterologists said that they occasionally discuss cost of care issues if patients raise the subject. About 46% of physicians overall said they do the same. Another 36% of gastroenterologists said they regularly discuss cost issues with patients – about the same proportion as among physicians in all specialties. Some 6% of gastroenterologists never discuss the issue because they themselves don't know the cost of the treatments, while 5% said they never discuss it because they don't believe it's appropriate.
Captions written by:
Mark Crane, Freelance writer, Brick, New Jersey
Disclosure: Mark Crane has disclosed no relevant financial relationships.
