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, pulmonologists earned a mean income of $242,000 -- slightly more than in the previous year. Of the 25 specialties surveyed, they are in the middle ranks in compensation. More than one third of pulmonologists earned $200,000 to $299,000. Some 13% earned $400,000 or more, while 14% earned $100,000 or less.
For employed pulmonologists, 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).
Almost 4 in 10 pulmonologists saw virtually no difference in income between 2010 and 2011. The same was true for physicians overall; in contrast, in the previous year, slightly more than half of pulmonologists saw little or no change in their earnings. This year, more than one third of pulmonologists reported a decrease in compensation, while only 26% saw an increase.
The gap in earnings between male and female pulmonologists has narrowed. Male pulmonologists reported a mean compensation of $248,000 as compared with $221,000 mean earnings for women. Male physicians overall earned 40% more than their female counterparts. For pulmonologists, males earn about 12% more than women, versus about 20% the previous year. 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
Pulmonologists in office-based solo practices earned the most, with a mean income of $312,000 -- about the same as the previous year. Members of multispecialty groups came in second, at $284,000, followed by those in single-specialty groups, at $274,000. Pulmonologists who are employees of hospitals or in academic/government setting earned the least.
The vast majority of physicians don't consider themselves to be rich, and that's true for pulmonologists as well. Although the public may perceive most physicians as wealthy, only 12% of pulmonologists agree with that characterization. A majority (51%) said that they don't feel rich because of much debt and high expenses, while 37% said that their income is no better than that of many nonphysicians.
One third of pulmonologists spends 41-50 hours per week seeing patients, a higher percentage than in last year's survey. About 17% spend 30-40 hours per week in patient encounters, about the same as 1 year ago. Some 14% report spending more than 60 hours seeing patients, while 13% spend 30 hours or less.
The highest percentage (25%) of pulmonologists has 50-75 patient visits per week, compared with about 15% of respondents who had this number of patient encounters in 2010. Three in 10 pulmonologists see 76-124 patients per week. Some 13% of respondents have fewer than 25 patient encounters, while 7% have 150 or more patient visits per week.
The patient care involved in pulmonology is time-intensive, and the length of patient visits reflects this. About 38% of pulmonologists reported patient encounters of longer than 20 minutes -- about the same as in last year's survey. One quarter of these physicians spend 13-16 minutes with each patient on average, and another one quarter spend 17-20 minutes. Only about 15% of pulmonologists spend 12 minutes or less per visit.
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 amount of time for pulmonologists. Almost 3 in 10 pulmonologists spend 5-9 hours per week on these tasks, and another 3 in 10 spend 10-14 hours per week -- similar to the proportions in the 2011 report. Only 23% of physicians overall spend 5 – 14 hours on administrative duties. Another 11% of pulmonologists spend more than 25 hours on non-patient-related activity, whereas 13% spend 4 hours or less.
Physician frustration is growing. The 2012 report shows far more dissatisfaction among doctors overall. Pulmonologists are generally happier with their lot, but not as many are as satisfied as they were previously. Whereas almost three quarters of these specialists reported in 2011 that they would still choose a career in medicine if they could do it all over again, only 60% felt that way in 2012. In addition, only one third of pulmonologists said they would choose the same specialty; last year, 52% of pulmonologists would do so. Finally, this year only 20% would choose the same practice setting, compared with about 48% in the previous year.
Despite the interest in alternative patient-care delivery models, only a small percentage of pulmonologists are currently involved. About 1% participate in Accountable Care Organizations (ACOs), but 7% say they plan to in the coming year. Only 1% of pulmonologists 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. Two thirds of pulmonologists we surveyed believe that ACOs will cause a decline in income (compared with 52% of physicians overall), while 5% say that they will have little or no effect on income. About 29% of pulmonologists 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 21% of pulmonologists said these measures will lead to better patient care -- a few percentage points less than for physicians overall (25%). About 40% of pulmonologists we surveyed believe the guidelines and quality measures will have a negative effect, while 39% said that they will have no impact on the quality of patient care.
More than 4 in 10 pulmonologists 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 interest. Almost half (43%) of all physicians agree. Another 19% of pulmonologists said that they won't change their routine because of the need to practice defensive medicine. One third of these physicians said that they would reduce the number of tests and procedures because the guidelines are valid. Another 4% would reduce tests and procedures because the guidelines will affect their income.
A majority (51%) of pulmonologists said that they occasionally discuss cost of care issues if patients raise the subject; this proportion is somewhat greater than among physicians overall (46%). More than one quarter of pulmonologists said they regularly discuss cost issues with patients. Some 11% never discuss the issue because they themselves don't know the cost of the treatments, while 10% said that 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.
