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, rheumatologists earned a mean income of $180,000, very similar to last year. Their compensation is in the lower half of the 25 specialties we surveyed. Around 13% earned more than $300,000, about the same proportion as in 2010. About 1 in 5 rheumatologists earned $100,000 or less.
For employed rheumatologists, 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).
A majority (52%) of rheumatologists saw virtually no difference in income between 2010 and 2011, about the same proportion as in last year's survey. Another 27% of these respondents saw an increase in their earnings, compared to 29% who saw an increase last year. About 22% reported a decrease between 2011 and 2010. Rheumatologists' income was more stable year over year than for physicians overall.
The gap in earnings between male and female rheumatologists is significant. Male physicians reported a mean compensation of $191,000 as compared with $149,000 mean earnings for women -- a 29% difference. 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 women physicians work part-time, which contributes to an overall lower income.
Rheumatologists in the North Central region (Iowa, Missouri, Kansas, Nebraska, and North and South Dakota) earned the most in 2011. Their mean income was $216,000 -- an increase over the previous year. The next-highest earners were rheumatologists in the Mid-Atlantic region, at $196,000, and the South Central region at $193,000. Rheumatologists in the Southwest earned the least, at a mean income of $140,000.
Rheumatologists who are members of office-based single-specialty group practices earned the most, with a mean income of $228,000; however, this is less than in the previous year. Members of multispecialty groups came in second, at $214,000. Rheumatologists in solo practice earned a mean income of $179,000. Rheumatologists who are employed by hospitals and in academic/government settings earned the least.
Physicians overall are nearly evenly split about whether they feel fairly compensated. Rheumatologists are more dissatisfied with their compensation. A majority (58%) said that they are unfairly compensated -- 9 percentage points more than for physicians overall. In the 2011 report, 53% of rheumatologists said that they were fairly compensated.
The vast majority of physicians don't consider themselves to be rich, and that's true for rheumatologists as well. Although the public may perceive most physicians as wealthy, only 6% of rheumatologists agree with that characterization. A majority (57%) said they that don't feel rich because their income is no better than that of many nonphysicians, while 37% feel that way because of much debt and high expenses.
The largest percentage (39%) of rheumatologists spends 30-40 hours per week seeing patients, the same as last year's survey. Almost one quarter of respondents spend 41-50 hours per week in patient encounters. One quarter of rheumatologists spend 30 hours or less seeing patients, while only 4% spend more than 60 hours per week in direct patient care.
The highest percentage (26%) of rheumatologists has 50-75 patient visits per week, about the same as in the previous year. The next-highest proportion of rheumatologists (23%) sees 76-99 patients per week. Some 11% of respondents have fewer than 25 visits, compared with 15% a year ago. Finally, 8% of rheumatologists have at least 150 visits per week.
The patient care involved in rheumatology is time-intensive, and the length of patient visits reflects this. About 3 in 10 rheumatologists spend 25 minutes or more on average with each patient, up from the year before. About 8% of rheumatologists report average visits of 12 minutes or less.
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.
One quarter of rheumatologists spend 5-9 hours per week on paperwork and administrative tasks. An almost equal percentage spends 10-14 hours per week. Only 23% of physicians overall spend from 5-14 hours on paperwork and administration. Another 14% of rheumatologists spend more than 25 hours performing non-patient-related chores, whereas 15% spend 4 hours or less.
Physician frustration is growing. The 2012 report show far more dissatisfaction among doctors across all specialties. Whereas in the 2011 survey, more than three quarters of rheumatologists told us that they would still choose a career in medicine if they could do it all over again, only 56% felt that way in 2012. Less than one half (42%) of rheumatologists said they would choose the same specialty -- down from 66% last year. Only 21% would choose the same practice setting, compared with about 50% last year.
Despite the interest in alternative patient-care delivery models, only a small percentage of rheumatologists are currently involved. About 2% participate in Accountable Care Organizations (ACOs), but 6% say they plan to do so in the coming year. Only 1% have concierge practices, and none 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. More than half (54%) of rheumatologists we surveyed believe that ACOs will cause either a large or slight decline in income (compared with 52% of physicians in all specialties), while 9% say that they will have little or no effect on income. About 38% 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 20% of rheumatologists said that these measures will lead to better patient care. Almost one half of the rheumatologists we surveyed believe the guidelines and quality measures will have a negative effect, while 32% said that they will have no impact on the quality of patient care.
Almost half (44%) of rheumatologists 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. Close to half (43%) of all physicians agree. Another 26% said that they won't change their routine because of the need to practice defensive medicine. About 18% of rheumatologists said that they would reduce the number of tests and procedures because the guidelines are valid. Another 11% would reduce tests and procedures because the guidelines will affect their income.
Captions written by:
Mark Crane, Freelance writer, Brick, New Jersey
Disclosure: Mark Crane has disclosed no relevant financial relationships.
