Tuesday, October 3, 2023
Emergency Medicine 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
Emergency Medicine Physician Compensation in 2012
Physicians have done well in 2012, and that's true for EM physicians as well. EM physicians were the 12th highest-ranked specialty, with a mean income of $270,000. Topping the list were orthopedists, cardiologists, radiologists, gastroenterologists, and urologists.
Historically, EM physicians have ranked in the middle among the specialties in Medscape's surveys, although there has been a slight decline. In our 2012 report, EM physicians ranked 14th highest, while in the previous year they were 11th from the top.
About 10% of EM physicians earn $400,000 or more, the highest income category in the specialty; 5% earn $100,00 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.
Emergency Medicine Physician Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been some movement in earnings for EM physicians. In 2012, 47% of respondents said that their compensation remained the same from the previous year, compared with 36% in 2011.
Similarly, in 2012, 33% of EM physicians said that they earned more than they earned in 2011, and 19% earned less. In 2011, 43% earned more than they had in 2010 and 20% earned less. In 2010, 31% reported an increase over the previous year, while 18% experienced a decline.
Do Men or Women Earn More?
There's still a pay gap between male and female physicians, regardless of specialty, but in emergency medicine the gap is narrower than most. Overall, male physicians earn 30% more than their female counterparts. In emergency medicine, however, that gap is a mere 14%, 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, 25% of EM 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%.
Emergency Medicine Physician Compensation by Geographical Region
EM physician compensation varies by region. Doctors in the South Central region, with the highest compensation ($298,000), earned more than their colleagues in the North East, with the lowest compensation ($242,000).
In 2011, there was also a spread. EM physicians earned the most in the North Central region; much more than EM physicians earning the least, in the North East.
Emergency Medicine Physician Compensation by Setting
In 2012, EM physicians who worked in hospitals were the top earners among various work settings, with a mean income of $277,000. EM physicians in single specialty group practices ranked next in earnings, with a mean income of $253,000, followed by those working in healthcare organizations.
Employed physicians ($250,000) earned more than owners of solo practices ($229,000), although partners beat them all ($298,000).
Do Emergency Medicine Physicians Feel Fairly Compensated?
Despite being in the middle of the pack in overall compensation, EM physicians are more satisfied with their earnings than are most other doctors, with 61% saying that they felt fairly compensated in 2012, identical to what they said in Medscape's 2011 Compensation Survey.
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 EM physicians less so than other doctors, the number of EM physicians who would choose medicine again as a career has declined nevertheless. Only 52% would do so in 2012 vs 56% in 2011.
Among EM physicians who said that they would opt in again, 41% would choose the same specialty in 2012, compared with 2011's 43%.
There were ripples of discontent about practice setting. In 2012, only 18% of EM physicians said that they would choose the same practice setting, compared with 24% in 2011.
Emergency Medicine Physicians' Participation in Various Payment Models
Clearly there are changes in the way that EM doctors are earning money.
Healthcare reform is having an impact. EM physicians saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 6% of EM physicians either participated in an ACO or planned to join one in the coming year. This year saw a large jump, to 18%.
The percentage of EM physicians in concierge medical practices or other cash-only practices remains small: 1% in both 2012 and 2011.
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 EM physicians, 2% plan to stop taking new Medicare or Medicaid patients, and 1% plan to stop seeing current Medicare or Medicaid patients. Another 15% 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, 82% of EM 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 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, fewer than 1 in 10 EM physicians (8%) 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 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.
Ancillary services are not much of a factor for EM physicians, however. Across all specialties, only 19% of doctors said that they had begun to add services. That percentage was slightly lower for EM physicians: 16%. By contrast, 22% of dermatologists, 19% of endocrinologists, and 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, only 21% of EM physicians said that they regularly discuss costs with patients, although another 59% said that they occasionally discuss costs, if a patient brings it up. In 2012, the percentage of EM physicians who regularly discuss costs with patients remains unchanged, and far fewer -- 46% -- 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 EM 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
The largest percentage of EM physicians 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, 47% worked 30-40 hours per week. In the previous year, about 53% worked those hours. In contrast, among all physicians, the greatest percentage (30%) also 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, 25% of EM physicians worked 30 hours or less per week (about the same as in 2011); 13% worked 41-45 hours (about the same as in 2011), and 7% worked 46-50 hours (also about the same). In the other categories of hours worked, the percentages of doctors were 3% or less -- mostly less -- in both 2012 and 2011.
Number of Patients per Week
EM physicians are among the busiest doctors. In 2012, 28% saw 50-75 patients per week (in 2011, it was nearly 35%), and 24% saw 76-99 patients per week (about the same as in 2011). Among all doctors, 20% see 50-75 patients per week and 15% see 76-99 patients per week.
As for the other ranges of patients seen, they look very similar from year to year. In 2012, 4% of EM physicians saw fewer than 25 patients per week, about the same as in 2011; 16% saw 100-124 patients per week, identical to 2011. What about the percentage of energetic doctors who see more than 200 patients per week? It was about 3% in both 2011 and 2012.
Amount of Time Spent With Each Patient
Due to the nature of the specialty, EM physicians spend a higher than average amount of time with each patient compared with many other types of doctors, and they spent significantly more time last year than the year before. For the largest percentage of EM physicians -- 28% in 2012 -- a mean of 17-20 minutes was the norm per patient visit. That represents an increase of 13 percentage points over 2011, when only 15% of EM doctors reported spending 17-20 minutes with patients.
Those who spent the least amount of time with patients -- less than 9 minutes --declined by 2 percentage points from 2011 to 2012 (14% vs 12%). In 2011, 36% of EM doctors spent 9-12 minutes with patients; in 2012, that number had declined to 25%. In 2011, 26% of doctors saw patients for 13-16 minutes; that number decreased to 22% the following year.
Hours Spent Seeing Patients in the Hospital
EM physicians, because of their specialty, spend a large portion of their time in the hospital with patients. A full 67% 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 EM physicians were less bogged down with such tasks than were many other specialists.
More than a third of EM doctors (36%) spent 1-4 hours on paperwork and administration each week, and another 27% spent 5-9 hours. Only 12% had 20 hours or more of paperwork per week.
That's in stark contrast 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 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 EM 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 40%; for physicians overall, that number was 34%.
For 31% of doctors overall, relationships with patients ranked next on the list in 2012. Among EM physicians, who tend not to have ongoing relationships with patients due to the nature of the specialty, only 15% felt the same, although it still ranked third as a factor in career satisfaction.
Good compensation ranked second in importance, with 16% of EM physicians citing it in 2012 compared with 9% of physicians overall.
When it came to citing pride in being a doctor, EM physicians in 2012 matched the mean for doctors overall: 7%.
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