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, HIV/infectious disease (ID) specialists earned a mean income of $170,000 -- about $5000 less than in the previous year. HIV/ID specialists are on the lower end of the income spectrum, earning just slightly more than psychiatrists, endocrinologists, pediatricians, internists, and family physicians. One quarter of HIV/ID physicians earned less than $125,000 -- a slightly higher percentage than a year ago. About 16% earned more than $250,000, about the same as last year.
For employed HIV/ID specialists, 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 53% of HIV/ID saw virtually no difference in income between Medscape's 2011 and 2012 survey report. This proportion was higher than for physicians overall, among whom 40% reported no change from 2010 to 2011. About 30% of HIV/ID specialists said they saw an increase in income in 2011 over 2010, while 18% reported a decrease for the same time period.
The gap in earnings between male and female HIV/ID specialists has widened. Male HIV/ID specialists reported a mean compensation of $186,000 as compared with $140,000 mean earnings for women, or 32% more. In last year's survey, the gap was less. 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.
HIV/ID specialists in the South Central region (Arkansas, Oklahoma, and Texas) earned the most, at a mean income of $294,000 -- an increase over the previous year. The next-highest earners were in the West, at $207,000. Physicians around the rest of the country earned considerably less. A year ago, HIV/ID specialists in the Northwest earned the most.
HIV/ID physicians in single specialty group practices earned the most, at a mean income of $254,000 – an increase from last year's survey. Physicians in solo practice came in second, at $200,000, which is about the same as a year ago. Those employed by hospitals ($168,000), healthcare organizations ($149,000), and academic settings ($116,000) earned considerably less.
Physicians across all specialties are nearly evenly split about whether they feel fairly compensated, and the same is true for HIV/ID specialists. Although compensation for these doctors is in the lower range of the specialties we surveyed, about 52% believe they are fairly compensated -- the same percentage as in last year's survey.
The vast majority of physicians don't consider themselves to be rich, and that's true for HIV/ID physicians as well. Although the public may perceive most physicians as wealthy, only 10% of HIV/ID specialists agree with that characterization. About 46% of these respondents said they don't feel rich because their income is no better than that of many nonphysicians, and 45% said that much debt and high expenses prevent them from feeling rich.
More than one quarter (28%) of HIV/ID specialists report seeing patients for less than 30 hours in an average week, and 22% spent 30-40 hours in direct patient care; both of these proportions are about the same as in last year's survey. Some 16% spent 51-65 hours seeing patients, while 9% spent more than 65 hours a week in direct patient care.
In contrast to the huge patient volume reported by primary care physicians and those in some other specialties, about 21% of HIV/ID physicians report seeing fewer than 25 patients per week. Another 24% see 25-49 patients, and 20% see 50-75 -- similar to last year's survey in both instances. Only 9% see more than 125 patients per week.
Given their comparatively smaller patient volumes, HIV/ID physicians are more likely than their colleagues in other specialties to spend more time with each patient. About 22% reported spending more than 25 minutes per patient visit, and an additional 40% spent 17-24 minutes -- about the same as a year ago. Only 4% said that they spend less than 9 minutes per visit, also the same as last year.
The amount of time per patient visits 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.
The highest percentage (27%) of HIV/ID specialists spends more than 25 hours per week on paperwork and administrative tasks, more than double the percentage who reported that amount of time in last year's survey. In contrast, only 13% of physicians across all specialties spent that amount of time. Some 43% of HIV/ID doctors spend 5-14 hours per week on administrative chores, while 9% spend 4 hours or less.
Physician frustration is growing. The 2012 report shows far more dissatisfaction among doctors across all specialties. Although HIV/ID specialists are generally happier with their lot than are other physicians, they are not as satisfied as they were 1 year ago. About 63% would still choose a career in medicine if they could do it all over again; last year, 70% said they would choose medicine again. About 54% of physicians overall would do the same. Some 46% of HIV/ID doctors would choose the same specialty, compared with 73% a year ago. Only one quarter would choose the same practice setting, compared with 48% in last year's survey.
Despite the interest in alternative patient-care delivery models, only a small percentage of HIV/ID physicians are currently involved. About 3% of HIV/ID specialists participate in Accountable Care Organizations (ACOs), but 6% say they plan to do so in the coming year. Not surprisingly, concierge practices and cash-only practices were very rare among this specialty.
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 (51%) of HIV/ID physicians we surveyed believe that ACOs will cause either a large or slight decline in income (compared with 46% of physicians in all specialties), while 13% say that they will have little or no effect on income. About 37% 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 29% of HIV/ID physicians said that these measures will lead to better patient care -- slightly higher than for physicians across all specialties (25%). About 47% of HIV/ID physicians believe the guidelines and quality measures will have a negative effect, while 24% said that they will have no impact on the quality of patient care.
Almost one half (45%) of HIV/ID physicians 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 interests. About two thirds (67%) of physicians overall agree. Another 17% of HIV/ID physicians said that they won't change their routine because of the need to practice defensive medicine. About 32% said that they would reduce the number of tests and procedures because the guidelines are valid. Another 5% would reduce tests and procedures because the guidelines will affect their income.
About 44% of HIV/ID physicians said that they occasionally discuss cost of care issues if patients raise the subject -- similar to proportion of physicians overall who do this (46%). Another 41% of HIV/ID specialists said they regularly discuss cost issues with patients (compared with 38% of physicians in all specialties). Some 9% of HIV/ID physicians 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
Mark Crane has disclosed no relevant financial relationships.
