Thursday, September 21, 2023
Dermatologist 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? Almost 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
Dermatologist Compensation in 2012
Physicians have done well in 2012, and dermatologists are near the top of the ranks. Dermatologists were the eighth highest ranked specialty, with a mean income of $306,000. Topping the list were orthopedists, cardiologists, radiologists, gastroenterologists, and urologists.
Historically, dermatologists have ranked high among the specialties in Medscape's surveys. In our 2012 and 2011 reports, dermatologists were also ranked eighth highest.
About 18% of dermatologists earn $500,000 or more; about 12% 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.
Dermatologist Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been very little movement in earnings for dermatologists. In 2012, 48% of respondents said that their compensation remained the same from the previous year, compared with 41% in 2011.
Similarly, in 2012, 30% of dermatologists said that they earned more than they earned in 2011, and 22% earned less -- similar 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 dermatology, however, that gap is 13%, less than in many other specialties.
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%.
Dermatologist Compensation by Geographical Region
Dermatologist compensation varies significantly by region. Doctors in the Great Lakes region, with the highest compensation (a mean of $333,000 in 2012), earn notably more than their colleagues in the Northeast, with the lowest compensation (a mean of $274,000 in 2012).
In 2011, there was also an income spread. Dermatologists earned the most in the West region, and least in the South Central region.
Dermatologist Compensation by Setting
Dermatologists who are partners were the top earners ($387,000) in 2012; dermatologists in multispecialty group practices were the second highest earners, with a mean income of $383,000. This is a touch higher than last year's figure of $382,000. On the lower end of the scale, those working in hospitals or academic settings earned less than those in other settings.
Owners of solo practices ($336,000) earned more than employed physicians ($240,000), although partners beat them all.
Do Dermatologists Feel Fairly Compensated?
More dermatologists feel fairly compensated than not (65% vs 35%), but this represents a gradual erosion in feelings about earnings fairness. In 2010, 70% of dermatologists felt fairly compensated. In 2011, that number was 71%.
Compared with all physicians, however, dermatologists feel much 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 dermatologists less so than other doctors, the number of dermatologists who would choose medicine again as a career has declined nevertheless. Only 37% would do so in 2012 vs 52% in 2011.
However, among dermatologists who said that they would opt in again, 74% would choose the same specialty in 2012, pretty close to 2011's 69%.
On the other hand, there were ripples of discontent about practice setting. In 2012, only 27% of dermatologists said that they would choose the same practice setting, compared with 35% in 2011.
Dermatologist Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Dermatologists saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 5% of dermatologists either participated in an ACO or planned to join one in the coming year. This year saw a large jump, to 18%.
Also, slightly more dermatologists have opted for cash-only practices in 2012 than in 2011 (5% vs 3%). But the numbers remained the same among dermatologists 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 dermatologists, 10% plan to stop taking new Medicare or Medicaid patients, and 2% plan to stop seeing current Medicare or Medicaid patients. Another 40% 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, 48% of dermatologists 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 2 in 5 dermatologists (43%) were planning to take this advice, or perhaps they do it already. But 17% were planning to keep all insurers because they felt that even poor payers represent revenue. Another 13% 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 dermatologists said yes. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was slightly higher for dermatologists: 22%. By contrast, 29% of plastic surgeons 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, 52% of dermatologists said that they regularly discuss cost with patients, although another 41% said that they occasionally discuss costs, if a patient brings it up. In 2012, even fewer dermatologists -- 44% -- said that they regularly discussed the cost of care with patients, although slightly more -- 44% -- 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.
Hours Spent Seeing Patients per Week
The largest percentage of dermatologists spends 30-40 hours per week seeing patients. The percentage of doctors who put in that amount of time has remained constant. In both 2012 and 2011, 52% worked 30-40 hours per week. In the previous year, roughly 55% worked those hours. In contrast, among all physicians, 30% worked a 30- to 40-hour week in 2012.
In 2012, 28% of dermatologists worked fewer than 30 hours a week (about the same as in 2011); 11% worked 41-45 hours (the same as in 2011), 4% worked 46-55 hours (a sizable decrease), and 3% worked 56 or more hours (essentially the same).
Number of Patients per Week
The sweet spot for dermatologists is 100-124 patient visits per week. In 2012, that accounted for 20% of dermatologists vs 22% in 2011 and nearly 23% in 2010. Patient loads in excess of 124 patients per week are common in dermatology. More than 1 in 3 (35%) of dermatologists saw that many patients in 2012, a little less than in 2011. On the opposite end of the spectrum, 6% of dermatologists saw fewer than 25 patients per week in 2012 vs 7% in 2011.
Amount of Time Spent With Each Patient
In general, dermatologists spend less time with each patient than do many other types of doctors. For the largest percentage of dermatologists -- 44% in 2012 -- a mean of 9-12 minutes was the norm per patient visit.
However, that percentage represents a small increase in the number of dermatologists who saw patients for that long in recent years. In 2011, 40% of dermatologists saw patients for 9-12 minutes; in 2010, that number was 43%.
About 12% of dermatologists see patients for less than 9 minutes, a percentage that has remained stable over the past 3 years. But the number of dermatologists who see patients for 13 minutes or longer has dropped a bit in the past year: In 2012, it was 44%; in 2011, it was 48%.
Hours Spent Seeing Patients in the Hospital
Dermatologists, because of the nature of their work, spend very little of their time in the hospital with patients. A full two thirds (67%) spend less than 1 hour per week seeing patients in the hospital. Another 28% spend 1-4 hours.
By contrast, 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 dermatologists were less bogged down with such tasks than were many other specialists.
More than 1 in 5 dermatologists (22%) spent 1-4 hours on paperwork and administration each week, and another 36% spent 5-9 hours. Only 12% had 20 hours or more of paperwork per week.
Looking at other specialists, 17% of family physicians 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 dermatologists, there are clearly plenty of emotional rewards that still have a strong impact. Among dermatologists, 42% felt that relationships with patients comprised the paramount reward. Among doctors overall, 31% ranked that their chief career satisfaction.
Being good at the practice of medicine was the paramount reward for 30% of dermatologists; for physicians overall, that number was very similar: 34%.
Good compensation ranked third in importance, with 11% of dermatologists citing it in 2012 compared with 9% for physicians overall.
When it came to the chief career reward, dermatologists were less likely than doctors overall (5% vs 7%) to note "being proud of being a doctor" as the most rewarding part of their job.
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