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, surgeons earned a mean income of $265,000 – a definite decrease from the previous year. About 9% of surgeons earned $500,000 or more, down from about 13% in last year's survey. Some 19% earned $100,000 or less. In 2010, about 10% earned that amount.
For employed surgeons, 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).
About 40% of surgeons saw virtually no difference in income between 2011 and 2010. This was true for physicians in all specialties. In last year's survey, 48% of surgeons saw no change. Another 32% of this year's respondents saw an increase in their earnings (compared with 21% last year) while 29% reported a decrease (compared with 25% last year).
The gap in earnings between male and female surgeons has widened. Male surgeons reported a mean compensation of $276,000 as compared with $223,000 mean earnings for women – a 24% difference. Overall, male physicians across all specialties earn 40% more than their female counterparts. Both men and women reported declines in mean income over the previous year.
Surgeons in the Great Lakes region (Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin) earn the most, with a mean income of $297,000, an increase over the previous year. The next highest earners are surgeons in the West, at $295,000, followed by those in the Southwest, at $285,000. Surgeons earn the least in the Northwest, at $233,000.
Surgeons employed by healthcare organizations earn the most, at a mean income of $339,000. Those who are members of single-specialty or multispecialty group practices have the next highest earnings, with mean incomes of $332,000 and $324,000 respectively. Hospital-employed surgeons earned the most in last year's report, but that's no longer true; they now earn about $226,000.
The vast majority of physicians don't consider themselves to be rich, and that's true for surgeons as well. Although the public may perceive most physicians as wealthy, only 11% of surgeons agree with that characterization. Almost half of the survey respondents said that they don't feel rich because of much debt and high expenses, while 41% said that their income is no better than that of many nonphysicians.
Slightly less than one quarter of surgeons spend between 30 and 40 hours per week seeing patients, somewhat more than in last year's survey. Another 24% of respondents spend 41-50 hours per week seeing patients. About 19% spend less than 30 hours per week with patients, compared with about 8% a year ago. Some 17% of these physicians spend more than 60 hours, compared with just less than 10% the previous year.
The number of patient visits per week for surgeons is stable. More than one third have 25-49 patient visits per week. Slightly less than one third have 50-75 patient encounters. That's virtually identical to what they said in last year's survey. About 9% of the respondents have at least 100 patient visits per week, down from 13% a year ago. About 15% of surgeons have fewer than 25 visits.
About 29% of surgeons spend 13-16 minutes with each patient on average. Another 22% spend 17-20 minutes on each patient encounter. This is practically the same response as reported in last year's survey. Visits lasting 25 minutes or more were reported by 14%. Only 6% of visits were less than 9 minutes long, also about the same as last year. These numbers don't account for time spent in surgery.
Responses were nearly evenly split for 5-9 hours (26%) and 10-14 hours (27%) spent by surgeons on paperwork and other administrative tasks in a given week, very close to the same as in last year's survey. Just over half (53%) of physicians overall spent less than 4 hours weekly on these obligations. Some 9% of surgeons spend less than 4 hours per week, while 11% report spending 25 hours or more.
Physician frustration is growing. The 2012 report shows far more dissatisfaction among doctors across all specialties. While more than two thirds (69%) of surgeon respondents told us last year that they would still choose a career in medicine if they could do it all over again, only 49% felt that way this year. Some 47% this year would choose the same specialty, compared with 60% last year. Roughly 1 in 5 surgeons would choose the same practice setting again, compared with 49% a year ago.
Despite the interest in alternative patient-care delivery models, only a small percentage of surgeons are currently involved. About 3% currently participate in Accountable Care Organizations (ACOs), but 6% say that they plan to 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 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 58% of surgeons we surveyed believe that ACOs will cause either a large or slight decline in income (compared with 52% of physicians in all specialties), while 11% say that they will have little or no effect on income. About 32% 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 18% of surgeons said that these measures will lead to better patient care, compared with 25% for physicians across all specialties. About 48% of surgeons believe the guidelines and quality measures will have a negative effect, while 34% said that they will have no impact on the quality of patient care.
Almost half of the surgeons we surveyed 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 27% of surgeons said that they won't change their routine because of the need to practice defensive medicine. About 22% 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.
A majority (51%) of surgeons said that they occasionally discuss cost of care issues if patients raise the subject. About 46% of physicians overall said that they do the same. Another 27% of surgeons regularly discuss cost issues with patients. Some 14% never discuss the issue because they themselves don't know the cost of the treatments, while 9% 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.
