Medscape Urologist Compensation Report: 2012 Results

• 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

Urologists were the fifth-highest earners in our survey, bested only by radiologists, orthopedic surgeons, cardiologists, and anesthesiologists. In 2011, urologists earned a mean income of $309,000. About 15% of urologists earn $500,000 or more, the same as in last year's survey. Some 19% earn $100,000 or less, also the same as a year ago.

For employed urologists, 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 over one third of urologists saw virtually no difference in income between their current and prior year's earnings. Another 40% of urologists saw a decrease in their earnings from last year, while 25% reported an increase, fairly similar to Medscape's 2011 survey.

The gap in earnings between male and female urologists is fairly substantial. Male urologists reported a mean compensation of $313,000 as compared with $253,000 mean earnings for women. Overall, male physicians across all specialties earn 40% more than their female colleagues.

Urologists in the West earn the most, at a mean income of $343,000 -- an increase over the prior year. In last year's survey, urologists in the South Central region earned the most. The next-highest earners this year were urologists in the Northwest, with a mean income of $340,000. Urologists in the Mid-Atlantic region earned the least, at $272,000 -- a decrease from last year. Physicians overall earned the most in the North Central region (Iowa, Kansas, Missouri, Nebraska, and North and South Dakota).

As in Medscape's 2011 survey, urologists in multispecialty group practices earned the most, with a mean income of $397,000 -- a decrease since last year's survey. Urologists in solo practice came in second, at $361,000 followed by those in single-specialty groups, at $355,000. Urologists employed in academic settings, hospitals, and outpatient clinics earned considerably less.

Although urologists are among the higher-earning physicians, only 40% said that their compensation is fair. That percentage is smaller than last year, when 47% of urologists felt their compensation was fair, and is somewhat less than the percentage of physicians overall who feel fairly compensated (51%).

The vast majority of physicians don't consider themselves to be rich, and that's true for urologists as well. Although the public may perceive most physicians as wealthy, only 11% of urologists agree with that characterization. A majority (51%) of urologists said that they don't feel rich because they have so many debts and expenses, while 38% said that their income is no better than that of many nonphysicians.

Just under one quarter of urologists spends 30-40 hours per week seeing patients, slightly more than in Medscape's 2011 survey. Another 36% of respondents spend 41-50 hours per week. About 11% spend less than 30 hours per week with patients, which represents little change from last year's survey. Finally, 12% of urologists spend more than 60 hours per week seeing patients, also similar to the percentage from the previous year.

The largest percentage of urologists (26%) sees 76-99 patients per week, which is the same as in Medscape's 2011 survey. About 13% of urologists see more than 124 patients per week, compared with 11% a year ago, and only 6% have fewer than 25 visits, about the same as last year.

About 37% of urologists spend 13-16 minutes with each patient on average -- about the same as in last year's survey. Another 27% of urologists spend 9-12 minutes. Visits lasting 20 minutes or more were reported by 8% of respondents. Only 11% of visits were less than 9 minutes long, about the same as last year.

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.

Responses were nearly evenly split for 5-9 hours (31%) and 10-14 hours (32%) spent by urologists on paperwork and administrative tasks in a given week. Only one quarter of physicians overall spent the same amount of time on these obligations. Some 12% of urologists spent less than 4 hours per week on administrative tasks, while 8% reported spending 25 hours or more.

Physician frustration is growing. The 2012 report shows far more dissatisfaction among doctors across all specialties. Some 51% of urologists said they would choose the same specialty if they had to do it over, compared with 78% in the 2011 survey report. Only 46% of urologists, said that they would choose medicine again as a career, compared with 65% in last year's report. Moreover, only 24% of urologists would choose the same practice setting again, compared with 50% in last year's survey.

Despite the interest in alternative patient-care delivery models, only a small percentage of urologists are currently involved. About 2% of urologists participate in Accountable Care Organizations (ACOs), but 5% say they plan to become involved in the coming year. Less than 1% of urologists have concierge practices, and 1% have a cash-only practice. 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 two thirds of urologists (68%) we surveyed believe that ACOs will cause either a large or slight decline in income (compared with 52% of physicians in all specialties), while 5% say that they will have little or no effect on income. About 27% 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 14% of urologists said that these measures will lead to better patient care, compared with 25% for physicians across all specialties. A majority (51%) of urologists believe that the guidelines and quality measures will have a negative effect, while 35% said they will have no impact on the quality of patient care.

Almost one half of the urologists 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 interest. Almost half (43%) of all physicians agree. Another 27% of urologists said that they won't change their routine because of the need to practice defensive medicine. About 20% of these doctors said that they would reduce the number of tests and procedures because the guidelines are valid. Another 6% would reduce tests and procedures because the guidelines will affect their income.

A majority (53%) of urologists said that they occasionally discuss cost of care issues if patients raise the subject. About 46% of physicians overall said that they do the same. Another 36% of urologists said they regularly discuss cost issues with patients, slightly less than physicians in all specialties. Some 7% never discuss the issue because they themselves don't know the cost of the treatments, while 4% said they never discuss it because they don't believe it's appropriate to do so.

Some 92% of urologists who responded to this survey are male. One third of are under age 45. About 83% of urologist respondents are board certified.

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

Disclosure: Mark Crane has disclosed no relevant financial relationships.