Medscape Pathologist Compensation Report: 2012 Results

For more information, see the following resources:

• 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, pathologists earned a mean income of $221,000 -- about the middle of the field in earnings among all physicians in this survey. About 1 in 5 pathologists earned more than $300,000, while 17% earned $100,000 or less.

For employed pathologists, 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).

One third of pathologists earned more in 2011 than they did in 2010, about the same as for physicians in all specialties. About 22% of pathologists reported a decline in income, while 45% said that their compensation had remained the same.

The gap in earnings between male and female physicians is smaller for pathologists than for many other specialties. Male pathologists earned a mean of $231,000 as compared with $212,000 for female pathologists -- a mere 9% difference. Across all specialties, male physicians earned about 40% more than their female counterparts. That's because many women physicians are more likely than men to work fewer hours, often choosing part-time schedules to balance work and family/lifestyle needs.

Pathologists in the Great Lakes region (Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin) earned the most, with a mean income of $257,000. The next-highest earners were pathologists in the South Central region, at $250,000. Pathologists earned the least in the Southwest, at $189,000. For physicians overall, those in the North Central region earned the most.

Pathologists in office-based single-specialty group practices earned the most -- a mean of $302,000 -- followed by those in office-based multispecialty groups, at a mean of $292,000. Pathologists employed by hospitals earned considerably less, at $221,000.

Whereas physicians overall are evenly divided about whether they are fairly compensated, pathologists are much happier with their lot. About 62% said they are content with their level of compensation. Only dermatologists have a higher percentage of satisfaction.

The vast majority of physicians don't consider themselves to be rich, and that's true for pathologists as well. Although the public may perceive most physicians as wealthy, only 14% of pathologists agree with that characterization. The rest are evenly divided between feeling that their income is no better than that of many nonphysicians and not feeling rich because of high expenses and debt.

Because pathologists tend to work in the laboratory rather than in direct patient care, almost one half of the pathologists we surveyed spend less than 30 hours per week seeing patients. As one pathologist commented, "We see "pieces" of patients, probably of the order of 25-50 per day from separate patients in surgical pathology." One in 5 pathologists spends an average of 30-40 hours per week on patient encounters. Only 7% spend more than 60 hours per week seeing patients.

The majority (57%) of pathologists have fewer than 25 patient visits per week, compared with 13% for physicians in all specialties. This would be expected, based on the nature of pathologists' work. One in 5 pathologists has 100 or more patient 'visits' per week.

Although pathologists see fewer patients than do physicians in other specialties, the time spent working on testing and examination for each patient tends to take significant time. One third of pathologists spend 13-20 minutes with each patient. About 23% spend 25 minutes or more, while 21% spend 9 minutes or less.

Paperwork, participation in professional organizations, clinical reading, and supervisory and administrative work take up a significant amount of time for pathologists. One third spend 25 or more hours per week on non-patient-related activities. Only 10% of physicians across all specialties spend that much time on these tasks. More than one quarter of pathologists spend 10-19 hours per week on non-patient-related activities, while 13% spend fewer than 4 hours.

Physician frustration is growing. The 2012 report shows far more dissatisfaction among doctors across all specialties. A bare majority (51%) of pathologists would choose a career in medicine if they could do it all over again -- about the same as physicians in all specialties. Only 47% would choose the same specialty again, and only 23% would select the same practice setting.

Despite the interest in alternative patient-care delivery models, only a small percentage of pathologists are currently involved. About 3% participate in Accountable Care Organizations (ACOs), but 4% say they plan to do so in the coming year. Less than 1% of pathologists 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 of pathologists (53%) believes that ACOs will cause a decline in income, while 11% say they will have little or no effect on income. About 36% of pathologists said it's too soon to tell.

Some elements of healthcare reform entail following treatment and quality guidelines set by insurers and Medicare for shared savings programs. Physicians are clearly skeptical that they will improve patients' quality of care. About 30% of pathologists said that these measures will lead to better patient care, compared with 25% among physicians in all specialties. Nearly one half of pathologists believe the measures will have a negative effect, compared with 47% for all physicians. About one quarter of pathologists said that the guidelines will have no impact on the quality of patient care -- the same as among all specialties.

Seven in 10 pathologists said that they have no intention of reducing the amount of tests, procedures, and treatments they perform on the basis of goals for quality guidelines and cost-containment or cost-effective treatment. A large majority (67%) of physicians in all specialties said the same.

About 45% of pathologists (compared with roughly 43% of physicians overall) said that they won't change their routine because the guidelines aren't in their patients' best interests. About 25% of pathologists said that they still need to practice defensive medicine, no matter what the guidelines. One quarter said they would reduce the number of tests and procedures because the guidelines are valid, and 6% would reduce tests and procedures because the guidelines will affect their income.

About 38% of pathologists said that they occasionally discuss cost issues if patients raise the subject. More than one third of pathologists (slightly less than for physicians overall) said they regularly discuss the cost of treatment with patients. About 15% never discuss the issue because they themselves don't know the cost of the treatments, while another 15% said they never discuss it because they don't believe it's appropriate to do so.

Some 59% of pathologists who responded to this survey are male. One third are under age 45. About 92% are board certified.

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

Mark Crane has disclosed no relevant financial relationships.