Monday, September 25, 2023
Anesthesiologist Compensation Report 2013
Is your income up or down? How is your practice changing? Are you drowning in paperwork, and would you do it all over again? Nearly 22,000 physicians gave answers to these and other intriguing questions about what it means to be a doctor these days and where their earnings are going.
Captions by Neil Chesanow, Senior Editor, Medscape Business of Medicine
Anesthesiologist Compensation in 2012
Physicians have done well in 2012, and anesthesiologists are near the top of the ranks. Anesthesiologists were the sixth highest ranked specialty, with a mean income of $317,000. Topping the list were orthopedists, cardiologists, radiologists, gastroenterologists, and urologists.
Historically, anesthesiologists have ranked high among the specialties in Medscape's surveys, although there has been a slight decline. In our 2012 report, anesthesiologists ranked fourth highest, while in the previous year they were third.
About 11% of anesthesiologists earn $500,000 or more; about 6% earn $100,000 or less.
For employed physicians, 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). Compensation in this chart includes only that for physicians working full-time.
Note: Totals in slideshow may not add up to 100% due to rounding. "Not applicable" (N/A) responses were not included in the charts and graphs.
Anesthesiologist Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been very little movement in earnings for anesthesiologists. In 2012, 46% of respondents said that their compensation remained the same from the previous year, compared with 41% in 2011.
Similarly, in 2012, 21% of anesthesiologists said that they earned more than they earned in 2011, and 33% earned less -- nearly identical to the earnings situation in 2011 compared with 2010.
Do Men or Women Earn More?
There's still a large pay gap between full-time male and female physicians, regardless of specialty. Overall, male physicians earn 30% more than their female counterparts. In anesthesiology, however, men earn 16% more than women.
One contributing factor involves women's choice of specialties. There are fewer women in some of the higher-paying specialties, which skews the overall percentages. For example, 23% of anesthesiologist survey respondents were women, whereas in some of the lower-paying specialties, such as pediatrics, 53% of respondents were women; for family medicine, it was 36%.
Anesthesiologist Compensation by Geographical Region
Anesthesiologist compensation varies significantly by region. Doctors in the North Central region, with the highest compensation (a mean of $383,000 in 2012), earn 20% more than their colleagues in the West, with the lowest compensation (a mean of $318,000 in 2012).
In 2011, the spread was not as wide. Anesthesiologists earned the most (a mean of $331,000) in the South Central region, while anesthesiologists earned the least in the West.
Why the high income in the North Central region? "There's less managed care, fewer doctors per capita, and a lower cost of doing business," says Tommy Bohannon, from Merritt Hawkins, a physician-recruiting company based in Irving, Texas.
Anesthesiologist Compensation by Setting
As in Medscape's 2012 Compensation Report, anesthesiologists in multispecialty group practices are the top earners by work setting, with a mean income of $374,000. This is somewhat lower than last year's figure of $396,000. Anesthesiologists in single-specialty groups, who are also among the highest earners, saw an even bigger income decline: $311,000 in 2012 vs $346,000 in 2011.
Employed physicians earned more than those in solo practice, although partners beat them all. Anesthesiologists working in hospitals earned a mean of $349,000 in 2012, an increase from $325,000 in 2011. Those working in healthcare organizations did slightly better in 2012 than in 2011. Anesthesiologists in office-based solo practices were at the bottom of the pack in 2012 with $276,000 but saw a large increase from 2011 ($222,000).
Do Anesthesiologists Feel Fairly Compensated?
More anesthesiologists feel fairly compensated than not (55% vs 45%), but this represents a gradual erosion in feelings about earnings fairness. In 2010, 63% of anesthesiologists felt fairly compensated. In 2011, that number was 59% -- despite the fact that anesthesiology is one of the highest-paid medical specialties.
Compared with all physicians, however, anesthesiologists feel more fairly compensated: Among all physicians, only 48% of doctors are satisfied with their pay.
If You Had to Do It All Over Again, Would You...
Although the changing healthcare environment appears to have affected anesthesiologists less so than other doctors, the number of anesthesiologists who would choose medicine again as a career has declined nevertheless. Only 39% would do so in 2012 vs 46% in 2011.
However, among anesthesiologists who said that they would opt in again, 46% would choose the same specialty in 2012, almost identical to 2011's 45%.
On the other hand, there were ripples of discontent about practice setting. In 2012, only 17% of anesthesiologists said that they would choose the same practice setting, compared with 20% in 2011.
Anesthesiologist Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Anesthesiologists saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 6% of anesthesiologists either participated in an ACO or planned to join one in the coming year. This year saw a huge jump, to 23%.
Also, very slightly more anesthesiologists have opted for concierge medical practices in 2012 than in 2011 (2% vs < 1%). The same is true of anesthesiologists who are in cash-only practices (3% vs 2%).
Will You Stop Taking Medicare or Medicaid Patients?
Many doctors, worried about potential low levels of Medicare reimbursement, are making the decision to stop taking those patients.
Among anesthesiologists, 6% plan to stop taking new Medicare or Medicaid patients, and 2% plan to stop seeing current Medicare or Medicaid patients. Another 25% are undecided.
That number (will stop taking new Medicare or Medicaid patients) is somewhat higher for the primary care specialties of internal medicine (11%) and family medicine (15%). Be that as it may, 67% of anesthesiologists are not conflicted and will continue seeing current and taking new Medicare and Medicaid patients. This compares with 59% of all doctors in 2012.
Will You Drop Insurers That Pay Poorly?
Most practice management experts advise doctors to review their payments by insurers on a yearly basis and be ready to drop those who are paying the worst or creating the most denials and problems.
In 2012, more than 1 in 5 anesthesiologists (21%) were planning to take this advice, or perhaps they do it already. But 22% were planning to keep all insurers because they felt that even poor payers represent revenue. Another 20% felt that dropping insurers that pay poorly was inappropriate behavior.
Have You Started Offering New Ancillary Services?
We asked doctors whether they have started providing additional medical services that were previously not considered standard offerings for their specialties, in order to increase income.
A great many anesthesiologists said yes. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was considerably higher for anesthesiologists: 30%. By contrast, 22% of dermatologists,19% of endocrinologists, and 29% of plastic surgeons (second highest percentage) added ancillary services.
Do You Discuss Cost of Treatment With Patients?
Cost of treatment is a big issue, particularly when there are options for different treatments. Given the increasing number of high-deductible health plans, treatment choices may be influenced by cost.
In 2011, only 16% of anesthesiologists said that they regularly discuss cost with patients, although another 45% said that they occasionally discuss costs, if a patient brings it up. In 2012, even fewer anesthesiologists -- 11% -- said that they regularly discussed the cost of care with patients, and far fewer -- 28% -- would discuss cost if the patient brought it up.
In contrast, among all doctors, 30% regularly discussed the cost of treatment with patients in 2012, another 38% did so if the patient brought it up, and 6% deemed costs inappropriate to discuss with patients.
In the case of anesthesiologists, it's likely that other personnel, such as the surgeon or hospital billing staff, discuss cost of treatment with patients.
Hours Spent Seeing Patients per Week
The largest percentage of anesthesiologists spends 46-50 hours per week seeing patients. The percentage of doctors who put in that amount of time has remained constant. In both 2012 and 2011, 21% worked 46-50 hours per week. In 2010, just under 20% worked those hours. In contrast, among all physicians, the greatest percentage (30%) worked a 30- to 40-hour week in 2012.
Along the majority of the time continuum, the number of hours worked were similar from one year to the next. In 2012, 16% of anesthesiologists worked a 30- to 40-hour week (the same as in 2011); 12% worked 41-45 hours (about the same as in 2011), 11% worked 51-55 hours (also about the same), and 5% worked 61-65 hours (in 2011, it was about 7%).
Number of Patients per Week
The sweet spot for anesthesiologists is 25-49 patient visits per week. In 2012, that accounted for 37% of anesthesiologists vs 36% in 2011 and nearly 40% in 2010. The next-largest group -- 24% in 2012, 28% in 2011, and slightly more than 25% in 2010 -- see fewer than 25 patients per week. Patient loads in excess of 100 patients per week are rare in anesthesiology. Only 11% of anesthesiologists saw that many patients in 2012, up from 9% in 2011.
Amount of Time Spent With Each Patient
Due to the nature of the specialty, anesthesiologists spend more time with each patient than do many other types of doctors. For the largest percentage of anesthesiologists -- 30% in 2012 -- a mean of 25 minutes or longer was the norm per patient visit.
However, that percentage represents a steep decline in the number of anesthesiologists who saw patients for that long in recent years. In 2011, 50% of anesthesiologists saw patients for 25 minutes or longer; in 2010, that number was 61%.
About 18% of anesthesiologists see patients for less than 13 minutes, a percentage that has remained stable over the past 3 years. But the number of anesthesiologists who see patients for 13-20 minutes has nearly doubled in the past year: In 2012, it was 35%; in 2011, it was 19%.
Hours Spent Seeing Patients in the Hospital
Anesthesiologists, because of their specialty, spend a large portion of their time in the hospital with patients. A full 65% spend 25 hours or more per week seeing patients in the hospital.
Other specialists who spent a considerable amount of time seeing patients in the hospital were cardiologists (24% spent more than 25 hours a week in the hospital) and critical care physicians (72%). Among internists that number was 29%, and among family physicians it was only 5%.
Hours Spent per Week on Paperwork and Administrative Activity
Most jobs entail paperwork and cumbersome chores. But anesthesiologists were less bogged down with such tasks than were many other specialists.
More than a third of anesthesiologists (36%) spent 1-4 hours on paperwork and administration each week, and another 29% spent 5-9 hours. Only 8% had 20 hours or more of paperwork per week.
That's in stark contrast to some of other specialists: For family physicians, only 17% had 1-4 hours of paperwork a week, and another 17% had 20 hours or more. Oncologists were also on the higher end of the paperwork continuum: Only 10% had 1-4 hours of paperwork per week, and 20% had 20 or more hours.
The Most Rewarding Part of Your Job
No matter what the public thinks, it's not all about the money. For anesthesiologists, there are clearly plenty of emotional rewards that still have a strong impact. Being good at the practice of medicine was the paramount reward for 35%; for physicians overall, that number was nearly identical: 34%.
For 31% of doctors overall, relationships with patients ranked next on the list in 2012. Among anesthesiologists, only 20% felt the same, although it was still second as a factor in career satisfaction.
Good compensation ranked third in importance, with 19% of anesthesiologists citing it in 2012 compared with 9% for physicians overall.
When it came to pride in being a doctor, anesthesiologists in 2012 took more pride than doctors overall: 10% vs 7%.
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