Medscape Nephrologist Compensation Report: 2012 Results

• Total respondents: 24,216 US physicians across 25 specialty areas
• Fieldwork conducted by Medscape from February 1-17, 2012
• Data collected via third-party online survey collection site

In 2011, nephrologists earned a mean income of $209,000 -- moderately less than in the previous year. The current survey revealed that nephrologists are in the middle range of compensation among specialties. About 27% of nephrologists reported that they earned more than $250,000, slightly less than a year ago. Some 11% earned less than $100,000.

For employed nephrologists, 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 38% of nephrologists saw virtually no difference in income between 2010 and 2011 -- a smaller percentage than in last year's survey, but about the same as for physicians overall. Another 25% of nephrologists saw a decrease in their earnings, while 37% said their income increased between 2010 and 2011.

Male nephrologists reported mean compensation of $222,000 as compared with $169,000 mean earnings for women. In last year's survey, the gap was smaller. Overall, male physicians across all specialties earned 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.

Nephrologists in the Northwest (Idaho, Montana, Oregon, Washington, and Wyoming) earned the most, with a mean income of $320,000 in 2011. The next-highest earners in 2011 were nephrologists in the West, at $274,000. For the second year in a row, nephrologists in the Northeast earned the least. Their mean income of $164,000 is less than it was a year ago.

Nephrologists in office-based multispecialty group practices earned the most, at a mean income of $308,000 -- an increase from the previous year. Those in solo practices came in second, at $235,000, up from a year ago. Physicians employed in hospitals and academic settings earned considerably less.

Physicians across all specialties are nearly evenly split about whether they feel fairly compensated. As in the 2011 survey, a majority (54%) of nephrologists said that they are unfairly compensated for their work.

The vast majority of physicians don't consider themselves to be rich, and that's true for nephrologists as well. Although the public may perceive most physicians as wealthy, only 10% of nephrologists agree with that characterization. Some 47% said that they don't feel rich because their income is no better than that of many nonphysicians, while 43% feel that way because of much debt and high expenses.

About 21% of nephrologists spend 30-40 hours per week seeing patients, slightly more than in last year's survey. Another 15% of respondents spend 41-45 hours per week in patient encounters. About 14% of nephrologists spend more than 60 hours per week seeing patients, and about 15% spend less than 30 hours per week in direct patient care.

About 3 in 10 nephrologists have fewer than 50 patient visits per week, similar to last year's survey. The largest percentage of physicians (22%) have 50-75 visits, compared with 17% a year ago. Just less than 10% have more than 150 patient visits per week, somewhat more than last year.

Survey results show that more than half (53%) of patient visits with nephrologists last from 13 to 20 minutes. Over a quarter of nephrologists spend more than 20 minutes with each patient on average -- a few percentage points less than last year. About 19% of nephrologists spends 12 minutes or less with each patient.

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.

About one quarter of nephrologists spend 5-9 hours per week on paperwork and administrative tasks, and one quarter spend 10-14 hours per week. Another 12% of nephrologists spend more than 25 hours on administrative chores (up from 7% a year ago), while 12% spend 4 hours or less (down from 14% the previous year).

Physician frustration is growing. The 2012 report shows far more dissatisfaction among doctors across all specialties. Whereas more than 70% of nephrologists told us last year that they would still choose a career in medicine if they could do it all over again, only 54% felt that way this year. About 38% of the respondents said they would choose the same specialty – down from 55% last year. Only 20% would choose the same practice setting, compared with about 41% last year.

Despite the interest in alternative patient-care delivery models, only a small percentage of nephrologists are currently involved. About 4% of nephrologists participate in Accountable Care Organizations (ACOs), but 8% say they plan to do so in the coming year. Only 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 (56%) of nephrologists we surveyed believe that ACOs will cause either a large or slight decline in income (compared with 52% of physicians in all specialties), while 12% say that they will have little or no effect on income. About 32% of nephrologists 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 30% of nephrologists said these measures will lead to better patient care -- 5 percentage points more than for physicians across all specialties. About 43% of nephrologists believe the guidelines and quality measures will have a negative effect, while 27% said that they will have no impact on the quality of patient care.

Four in 10 nephrologists said that they have no intention of reducing the amount of tests, procedures, and treatments they perform because they believe the quality guidelines and cost-containment measures aren't in patients' best interest. Another 18% said they won't change their routine because of the need to practice defensive medicine. About 29% of nephrologists said that they would reduce the number of tests and procedures because the guidelines are valid. Another 13% would reduce tests and procedures because the guidelines will affect their income.

One half of nephrologists said that they occasionally discuss cost of care issues if patients raise the subject -- a somewhat greater proportion than among physicians overall (46%). One third of nephrologists said they regularly discuss cost issues with patients. Some 7% 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.

Some 77% of nephrologists who responded to this survey are male. Just over half (52%) of respondents are under age 45. About 98% are board certified.

Captions written by:
Mark Crane, Freelance writer, Brick, New Jersey

Disclosure: Mark Crane has disclosed no relevant financial relationships.