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, pediatricians earned a mean income of $156,000—an increase over the previous year. However, pediatricians earned the least of the specialties surveyed in both years. Almost one quarter of pediatricians (24%) earned $100,000 or less—an increase over the figures reported in Medscape's 2011 survey, About 12% of pediatricians earned $250,000 or more, about the same as a year ago.
For employed pediatricians, 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).
The gap in earnings between male and female pediatricians still exists. Male physicians reported a mean compensation of $180,000 as compared with $137,000 mean earnings for women -- a 32% difference. The gap was smaller in last year's survey. Male physicians overall earned 40% more than their female counterparts, and male pediatricians earned 32% more than female pediatricians. According to Tommy Bohannon, divisional vice president of Merritt Hawkins (a physician recruitment firm), more women physicians work part-time, which contributes to an overall lower income.
As for physicians overall, pediatricians earned the most in the North Central area (Iowa, Kansas, Missouri, Nebraska, and North and South Dakota). Their mean income of $183,000 is an increase of $24,500 over the previous year. The next-highest earners in 2011 were pediatricians in the Northwest, with a mean income of $179,000 -- a $30,000 increase over 2010. Pediatricians in the West and Northeast earned the least, at a mean income of $146,000 – still an increase for both regions since last year.
Pediatricians in office-based single groups earned the most, at a mean income of $170,000.Those in solo practice came in second, at $167,000 and pediatricians in multispecialty groups were third, at $166,000. Pediatricians in academic settings, hospitals, and outpatient clinics earned considerably less.
The vast majority of physicians don't consider themselves to be rich, and that's true for pediatricians as well. Although the public may perceive most physicians as wealthy, only 9% of pediatricians agree with that characterization. A majority (54%) said their income is no better than that of many nonphysicians, while 38% said that they don't feel rich because of so many debts and expenses.
The largest percentage (37%) of pediatricians spends 30-40 hours per week seeing patients—a number that is virtually unchanged from 2010. A little over one quarter (27%)of pediatricians spent less than 30 hours per week with patients (up from about 20% a year ago), while 5% reported spending more than 60 hours per week seeing patients.
Some 36% of pediatricians have 25-75 patient visits per week, a few percentage points less than in last year's report. A similar number of these doctors sees 76-124 patients per week, also down slightly from 1 year ago. About 1 in 8 pediatricians (13%) has fewer than 25 patients visits per week, while 7% see 150 or more patients.
Survey results show that patient visits with pediatricians are generally substantial. More than one third (34%) of pediatricians spend 13-16 minutes with each patient, and 23% spend 9-12 minutes. Only 4% of visits are less than 9 minutes long. About 13% of pediatricians conduct patient visits of 25 minutes or more.
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.
Paperwork and administrative tasks take up a significant portion of time for pediatricians. A majority (53%) of pediatricians spend 5-14 hours per week on paperwork and other non-patient-related activities, about the same as in last year's survey. About 10% of pediatricians spend 25 hours or more per week on these administrative chores, a few percentage points higher than last year. Nearly one in 5 pediatricians (19%) said they spend 4 hours or less on these tasks.
Physician frustration is growing. The 2012 report shows far more dissatisfaction among doctors overall. That's true for pediatricians as well. Some 59% of pediatrician respondents said that they would choose a career in medicine if they could do it all over again, compared with about 74% of last year's respondents -- a significant decline. In addition, only about 46% of pediatricians would choose the same specialty; last year, 62% said they would. In 2011, only 27% of pediatricians would choose the same practice setting, compared with 52% in 2010. For physicians overall, just over one half (54%) would go into medicine again.
Despite the interest in alternative patient-care delivery models, only a small percentage of pediatricians are currently involved. About 3% participate in Accountable Care Organizations (ACOs), but 5% say that they plan to do so in the coming year. Only 1% have concierge practices, and 1% have cash-only practices.
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. About 45% of pediatricians surveyed believe that ACOs will cause a decline in income (compared with 52% of physicians overall), while 13% say that they will have little or no effect on income. About 42% 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 one third of pediatricians (32%) said these measures will lead to better patient care, compared with 25% of physicians overall. About 41% of pediatricians believe the guidelines and quality measures will have a negative effect, while 28% said they will have no impact on the quality of patient care.
About 45% of pediatricians 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. Almost half (43%) of all physicians agree. Another 15% of pediatricians said they won't change their test and procedure recommendations because of the need to practice defensive medicine (versus 24% for all physicians surveyed). More than one third of pediatricians (34%) said that they would reduce the number of tests and procedures because the guidelines are valid, compared with 27% of physicians overall. Finally, 6% of pediatricians would reduce tests and procedures because the guidelines will affect their income.
A majority (54%) of pediatricians said that they occasionally discuss cost of care issues if a patient raises the subject. About 46% of physicians overall said that they do the same. Another 29% of pediatricians regularly discuss costs with patients, compared with 38% for physicians overall. Some 10% never discuss the issue because they themselves don't know the cost of the treatments, while 7% said they never discuss it because they don't believe it's appropriate to do so (about the same as for physicians overall).
Captions written by:
Mark Crane, Freelance writer, Brick, New Jersey
Disclosure: Mark Crane has disclosed no relevant financial relationships.
