Sunday, September 24, 2023
Cardiologist 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? Close to 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
Cardiologist Compensation in 2012
Physicians have done well in 2012, and cardiologists are near the top of the ranks. Cardiologists were the second-highest-ranked specialty, with a mean income of $357,000. Only orthopedists did better, with $405,000 in annual compensation. Orthopedists and cardiologists were followed by radiologists, gastroenterologists, and urologists.
Historically, cardiologists have ranked high among the specialties in Medscape's surveys. In our 2012 report, cardiologists ranked third highest, while in the previous year they were fourth.
About 23% of cardiologists earn $500,000 or more; about 8% 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.
Cardiologist Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been some slight movement in earnings for cardiologists. In 2012, 42% of respondents said that their compensation remained the same from the previous year, compared with 35% in 2011.
Similarly, in 2012, 18% of cardiologists said that they earned more than they earned in 2011, and 39% earned less. The numbers were 25% and 41%, respectively, in 2011 compared with 2010.
Do Men or Women Earn More?
There's still a large pay gap between male and female physicians, regardless of specialty. Overall, male physicians earn 30% more than their female counterparts. In cardiology, however, men earn 17% 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, just 11% of cardiologist 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%.
Cardiologist Compensation by Geographical Region
Cardiologist compensation varies significantly by region. Doctors in the Northwest region, with the highest compensation (a mean of $403,000 in 2012), earn 30% more than their colleagues in the Northeast, with the lowest compensation (a mean of $311,000 in 2012).
In 2011, the spread was wider. Cardiologists earned the most (a mean of $379,000) in the North Central region.
Cardiologist Compensation by Setting
As in Medscape's 2012 Compensation Report, cardiologists in single-specialty group practices are the top earners by work setting, with a mean income of $410,000. This is somewhat higher than last year's figure of $388,000. Cardiologists who are employees of healthcare organizations, who are also among the highest earners, saw an even bigger income jump over the prior year.
Employed physicians earned more than those in solo practice, although partners beat them all. Cardiologists working in hospitals earned a mean of $314,000 in 2012, a huge increase from $254,000 in 2011. Those working in multispecialty group practices also enjoyed a nice bump in 2012 over 2011. Cardiologists in academic settings were at the bottom of the pack in 2012 with $230,000 but saw a large increase from 2011 ($192,000).
Do Cardiologists Feel Fairly Compensated?
About 42% of cardiologists feel fairly compensated vs 58% who believe that they are underpaid, which represents a gradual erosion in feelings about earnings fairness. In both 2010 and 2011, 46% of cardiologists felt fairly compensated -- despite the fact that cardiology is one of the highest-paid medical specialties.
Compared with all physicians, cardiologists feel less fairly compensated: Among all physicians, 52% 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 cardiologists less so than other doctors, the number of cardiologists who would choose medicine again as a career has declined nevertheless. Only 40% would do so in 2012 vs 48% in 2011.
However, among cardiologists who said that they would opt in again, 54% would choose the same specialty in 2012, very close to 2011's 50%.
On the other hand, there was significant discontent about practice setting. In 2012, only 15% of cardiologists said that they would choose the same practice setting, compared with 18% in 2011.
Cardiologist Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Cardiologists saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 11% of cardiologists either participated in an ACO or planned to join one in the coming year. This year saw a huge jump, to 32%.
Also, slightly more cardiologists have opted for cash-only practices in 2012 than in 2011 (2% vs 1%). But the numbers remained the same among cardiologists who are in concierge medical practices (1%).
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 cardiologists, 8% plan to stop taking new Medicare or Medicaid patients, and 1% plan to stop seeing current Medicare or Medicaid patients. Another 27% are undecided.
That number (who 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, 64% of cardiologists 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 Who 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 4 cardiologists (26%) were planning to take this advice, or perhaps they do it already. But 29% were planning to keep all insurers because they felt that even poor payers represent revenue. Another 19% 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 fair amount of cardiologists said yes. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was slightly higher for cardiologists: 22%. 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, 1 in 3 (34%) cardiologists said that they regularly discuss cost with patients, although another 53% said that they occasionally discuss costs, if a patient brings it up. In 2012, even fewer cardiologists -- 28% -- said that they regularly discussed the cost of care with patients, and 51% 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 cardiologists, 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 cardiologists spend 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, roughly 17% worked 46-50 hours per week. In the previous year, about 19% worked those hours.
Along the majority of the time continuum, the number of hours worked were similar from one year to the next. In 2012, 13% of cardiologists worked 41-45 hours (about the same as in 2011), 9% worked 51-55 hours (slightly less than before), and 6% worked 61-65 hours (in 2011, it was about 7%). On the low end, 13% of cardiologists saw patients for less than 30 hours per week (about the same as in 2011). Going the other way, 14% of cardiologists saw more than 65 patients a week, up from roughly 11% in 2011.
Number of Patients per Week
The sweet spot for cardiologists is 50-75 patient visits per week. In 2012, that accounted for 26% of cardiologists vs 25% in 2011, and about 18% in 2010. Patient loads in excess of 100 patients per week are common in cardiology. Some 30% of cardiologists saw that many patients in 2012, roughly the same number as in 2011.
Amount of Time Spent With Each Patient
Due to the nature of the specialty, cardiologists spend a fair amount of time with each patient. For the largest percentage of cardiologists -- 38% in 2012 -- a mean of 13-16 minutes was the norm per patient visit.
That percentage represents an increase in the number of cardiologists who saw patients for that long in recent years. In 2011, 31% of cardiologists saw patients for 13-16 minutes; in 2010, that number was about 26%.
About 3% of cardiologists see patients for less than 9 minutes, a percentage that has remained stable over the past 3 years. But the number of cardiologists who see patients for 25 minutes or more has dropped in the past year: In 2012, it was 11%; in 2011, it was 14%.
Hours Spent Seeing Patients in the Hospital
Cardiologists, because of the nature of their work, spend a large portion of their time in the hospital with patients. Almost 1 in 4 (24%) spends 25 hours or more per week seeing patients in the hospital.
By contrast, a full 72% of critical care physicians spent more than 25 hours a week in the hospital. 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. Cardiologists were considerably bogged down with such tasks.
One in 7 cardiologists (15%) spent 1-4 hours on paperwork and administration each week, and another 25% spent 5-9 hours. About 18% had 20 hours or more of paperwork per week.
That's comparable to some 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 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 cardiologists, 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 36%; 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 cardiologists, 35% felt the same, although it was still a close second as a factor in career satisfaction.
Good compensation ranked third in importance, with 9% of cardiologists citing it in 2012, the same as for physicians overall.
When it came to pride in being a doctor, cardiologists in 2012 took a bit more pride than doctors overall: 8% vs 7%.
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