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, plastic surgeons earned a mean income of $270,000 – about the same as a year ago. These specialists are among the top half in earnings in our survey. Almost one quarter of plastic surgeons earned between $200,000 and $299,000. However, another one quarter earned less than $100,000, compared with about 12% who earned that amount in 2010. About 9% of plastic surgeons earned $500,000 or more, compared with 16% in last year's report.
For employed plastic 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).
Just under one third of plastic surgeons saw virtually no difference in income between 2011 and 2010. In contrast, in last year's report, just under half of plastic surgeons said that their income had remained unchanged from the year before. Another 27% of plastic surgeons saw a decrease in their earnings in 2011, while 42% reported an increase.
The gap in earnings between male and female plastic surgeons is substantial. Male plastic surgeons reported mean compensation of $290,000 as compared with $187,000 mean earnings for women -- a 55% difference. The gap was also large in last year's survey. Male physicians overall earned 40% more than their female colleagues. 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.
Plastic surgeons in the Southwest region (Arizona, Colorado, Nevada, New Mexico, and Utah) earned the most, at a mean income of $416,000. In last year's survey, plastic surgeons in the Great Lakes region earned the most. The next-highest earners in 2011 were plastic surgeons in the North Central region, at a mean income of $413,000. Plastic surgeons in the Southeast earned the least. Physicians overall earned the most in the North Central region.
Plastic surgeons in multispecialty group practices earned the most, at a mean income of $445,000 -- a slight decrease since last year's survey. Plastic surgeons employed by healthcare organizations came in second, followed by those in single-specialty groups. Plastic surgeons employed in academic settings and hospitals earned considerably less.
Physicians overall are nearly evenly split about whether they feel fairly compensated. Plastic surgeons are more dissatisfied. Although they were among the highest-earning physicians in our survey, 63% of plastic surgeons said that their compensation is unfair. In the 2011 report, less than one half of plastic surgeons felt that way.
The vast majority of physicians don't consider themselves to be rich, and that's true for plastic surgeons as well. Although the public may perceive most physicians as wealthy, only 6% of plastic surgeons agree with that characterization. Some 47% of plastic surgeons said that they don't feel rich because of so many debts and expenses, while another 47% said that their income is no better than that of many nonphysicians.
Just under one third of plastic surgeons spend 30-40 hours per week seeing patients, down from 25% in last year's survey. Another 27% of respondents spend 41-50 hours per week. One in 5 plastic surgeons spends less than 30 hours per week seeing patients. Another 9% spend more than 60 hours, slightly less than the previous year.
More than 4 in 10 plastic surgeons have 25-49 patient visits per week, up from 29% in last year's survey. Just under one quarter of plastic surgeons see 50-75 patients per week, compared with 35% in 2010. Some 17% of respondents have fewer than 25 visits per week, while 6% have more than 100 visits.
Survey results show that patient visits with plastic surgeons are generally substantial. About 23% of plastic surgeons spend 13-16 minutes with each patient on average, and just about the same percentage spends 17-20 minutes per patient -- both similar to last year's survey. Another 22% spend 25 minutes or more per visit, while 8% typically spend less than 9 minutes. The numbers don't account for time spent in surgery.
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.
More than one third of plastic surgeons spend 10-14 hours per week on paperwork and administrative tasks -- about the same as in last year's survey. About 55% of physicians overall spend 4 hours or less on these obligations. Some 13% of plastic surgeons spend less than 4 hours per week, while 13% report spending 20 hours or more.
Physician frustration is growing. The 2012 report shows far more dissatisfaction among doctors across all specialties. The degree of satisfaction among plastic surgeons decreased dramatically over the past year: Whereas 62% of respondents told us in 2010 that they would still choose a career in medicine if they could do it all over again, only 35% felt that way in 2011. In addition, only one half of the plastic surgeons said they would choose the same specialty, compared with an extraordinary 82% last year. Only 18% would choose the same practice setting again, compared with 53% a year ago.
Despite the interest in alternative patient-care delivery models, only a small percentage of plastic surgeons are currently involved. About 3% participate in Accountable Care Organizations (ACOs), but 3% say they plan to do so in the coming year. About 1% of plastic surgeons have concierge practices, while 16% 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 (54%) of plastic surgeons we surveyed believe that ACOs will cause either a large or slight decline in income (compared with 52% of physicians overall), while 16% say they will have little or no effect on income. About 30% of plastic surgeons 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. Only 12% of plastic surgeons said these measures will lead to better patient care, compared with 5% for physicians overall. A majority (61%) of plastic surgeons believe the guidelines and quality measures will have a negative effect, while 27% said they will have no impact on the quality of patient care.
A majority (52%) of the plastic 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 interests. Almost half (43%) of all physicians agree. Another 29% of plastic surgeons said that they won't change their routine because of the need to practice defensive medicine. About 13% 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 plastic surgeons said that they regularly discuss cost of care issues with patients, compared with 38% of physicians overall. More than one third of plastic surgeons said that they occasionally discuss cost if patients raise the subject; in comparison, 46% of physicians overall said they do the same. Some 8% never discuss the issue because they themselves don't know the cost of the treatments, while 5% 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.
