Thursday, September 28, 2023
Critical Care Physician 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
Critical Care Physician Compensation in 2012
Physicians have done well in 2012. Critical care physicians' income ranked about midway out of 25 specialties, with a mean income of $268,000. Topping the list were orthopedists, cardiologists, radiologists, gastroenterologists, and urologists.
In 2011, critical care physicians also ranked in the middle of the specialties covered in Medscape's survey, although there has been a significant uptick since then. In our 2012 report, critical care physicians ranked thirteenth highest and earned an income of $240,000.
About 4% of critical care physicians earn $500,000 or more; about 9% 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.
Critical Care Physician Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been very little movement in earnings for critical care physicians. In 2012, 48% of respondents said that their compensation remained the same from the previous year, compared with 41% in 2011.
Similarly, in 2012, 33% of critical care physicians said that they earned more than they earned in 2011, and 19% earned less -- close to the earnings situation in 2011, when 36% of these doctors said that they earned more and 23% said that they earned less.
Do Men or Women Earn More?
Male physicians earn more than female physicians, regardless of specialty. Overall, male physicians earn 30% more than their female counterparts. In critical care, however, that gap is 42%, more than in most other specialties.
One factor contributing to the overall gender pay gap 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 critical care physician 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%.
Critical Care Physician Compensation by Geographical Region
Critical care physician compensation varies by region. Doctors in the Southeast, with the highest compensation (a mean of $311,000 in 2012), earned much more than their colleagues in the Northeast, with the lowest compensation.
In 2011, there was also a regional variance. Critical care physicians earned the most in the West, and the least in the Mid-Atlantic region. In fact, critical care physicians have seen swings in earnings in every region over the past 2 years.
Critical Care Physician Compensation by Setting
From 2011 to 2012, earnings by critical care physicians saw fluctuations, depending on the practice setting.
Critical care physicians in multispecialty group practices were the highest earners, with a mean income of $375,000; their earnings increased from the prior year's survey. Critical care physicians in hospitals saw their earnings rise from 2011 to 2012.
Employed critical care physicians earned substantially less than those in solo practice ($258,000 vs $335,000) in 2012. Owners of solo practices even outearned partners last year.
Do Critical Care Physicians Feel Fairly Compensated?
About 47% of critical care physicians feel fairly compensated vs 53% who believe that they are underpaid. This is almost the opposite of what critical care physicians reported in Medscape's 2012 Compensation Report: 55% said that they were fairly compensated and 45% felt otherwise. This, despite the fact that 39% of critical care doctors earned over $300,000 in 2012.
Compared with all physicians, critical care physicians are nearly identical to the mean: 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 critical care physicians more than many other doctors, and despite the fact that the majority are unsatisfied with their earnings, more than half of critical care doctors (54%) would choose medicine again as a career. And that number has gone up. In 2011, 51% said that they would become doctors again if given a second chance.
However, among critical care physicians who said that they would opt in again, fewer than half would choose the same specialty: 44% in 2012 and 43% in 2011.
In addition, there were ripples of discontent about practice setting. In 2012, only 19% of critical care physicians said that they would choose the same practice setting, compared with 20% in 2011.
Critical Care Physician Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Critical care physicians saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 12% of critical care physicians either participated in an ACO or planned to join one in the coming year. This year saw a huge jump, to 29%.
However, slightly fewer critical care physicians have opted for concierge medical practices in 2012 than in 2011 (2% vs 3%). The same is true of critical care doctors who are in cash-only practices (2% vs 4%).
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 critical care physicians, 5% plan to stop taking new Medicare or Medicaid patients, and 1% plan to stop seeing current Medicare or Medicaid patients. Another 23% 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, 72% of critical care physicians 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, only 13% of critical care physicians were planning to take this advice, or perhaps they do it already. But 18% were planning to keep all insurers because they felt that even poor payers represent revenue. Another 32% 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.
An above-average number of critical care physicians said yes. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was only slightly higher for critical care physicians: 22%. By comparison, 22% of dermatologists, 19% of endocrinologists, and 29% of plastic surgeons (the second highest percentage) added ancillary services in 2012.
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 23% of critical care physicians 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 critical care physicians -- 14% -- said that they regularly discussed the cost of care with patients, and far fewer -- 38% -- 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 critical care physicians, it's likely that other personnel, such as the hospital billing staff, discuss cost of treatment with patients.
Hours Spent Seeing Patients per Week
Although in many specialties the majority of doctors tend to cluster within 1 or 2 time ranges in hours spent seeing patients per week, this isn't true of critical care physicians. They are much more evenly distributed across the time continuum. In 2012, the largest number, 16%, spent 46-50 hours seeing patients per week. But 15% saw patients for 30-40 hours per week, 14% saw patients for 41-45 hours per week, and another 14% saw patients for more than 65 hours per week.
In fact, it's among the hardest-working doctors -- those who see patients for more than 65 hours per week -- that the year-to-year difference is most dramatic. In 2011, just over a quarter (26%) of critical care physicians worked that hard. Year-to-year movement in other categories of hours spent seeing patients per week was very slight if at all.
Number of Patients per Week
There are 2 sweet spots for critical care physicians: 25-49 and 50-75 patient visits per week. In 2012, these 2 ranges accounted for 48% (24% each) of critical care physicians vs 50% in 2011. The next-largest group -- 16% in 2012 -- saw fewer than 25 patients per week, vs 10% in 2011. Patient loads in excess of 100 patients per week are common in critical care medicine. More than 1 in 5 doctors (21%) saw that many patients in 2012, slightly down from about 25% in 2011.
Amount of Time Spent With Each Patient
The amount of time clinical care physicians spend with each patient has changed in nearly every category from 2011 to 2012. In 2011, nearly half of clinical care physicians (44%) spent 25 minutes or more with each patient; in 2012, only 20% did. In 2012, nearly a third of doctors (30%) saw patients for 17-20 minutes; in 2011, 22% did.
Many more clinical care physicians are seeing patients for 16 minutes or less now than they did previously. In 2012, 20% saw patients for 13-16 minutes, and another 20% saw them for 9-12 minutes, vs 11% and 14%, respectively, in 2011.
Hours Spent Seeing Patients in the Hospital
Critical care physicians, because of the nature of their work, spend a large portion of their time in the hospital with patients. A full 72% 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 in 2012 were cardiologists (24% spent more than 25 hours a week in the hospital) and radiologists (23%). 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, and critical care physicians have plenty of them. Over half (52%) spent 5-14 hours per week on paperwork in 2012; in 2011, 42% did.
About 14% of critical care physicians spent 1-4 hours on paperwork and administration each week, and another 25% spent 5-9 hours. More than 1 in 5 (22%) spent more than 20 hours a week on paperwork in 2012, although in 2011, the number of doctors who worked that hard was significantly higher: 32%.
That's similar to the hours spent on paperwork by other specialists who do a fair amount of it: 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 critical care physicians, 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 47%; for physicians overall, that number was considerably lower: 34%.
For 31% of doctors overall, relationships with patients ranked next on the list in 2012. Among critical care physicians, only 18% felt the same, although it was still second as a factor in career satisfaction.
Considering that critical care doctors are among the most dissatisfied with their compensation, good compensation ranked fifth in importance (6%), below knowing that one is making the world a better place (15%) and having pride in being a doctor (9%). In 2012, good compensation was key to 9% of physicians overall.
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