Friday, September 29, 2023
Family 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? 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
Family Physician Compensation in 2012
In 2012, family physicians earned a median annual income of $175,000, which represents an increase from 2011 -- a positive move in a rocky economy. Nevertheless, family physicians remain at the lower end of the earnings spectrum in Medscape's surveys, along with internists and pediatricians.
About 7% of family physicians earn $300,000 or more; about 13% 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.
Family Physicians Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been very little movement in earnings for family physicians. In 2012, 47% of respondents said that their compensation remained the same from the previous year, compared with 40% in 2011.
Similarly, in 2012, 32% of family physicians said that they earned more than they earned in 2011, and 21% earned less. In 2011, 38% of family physicians said that their earnings increased vs 2010, while 22% said that their income declined.
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 family medicine, however, that gap is 17%, 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%.
Family Physician Compensation by Geographical Region
Family physicians' compensation varies somewhat by region. Doctors in the North Central region, with the highest compensation (a mean of $186,000 in 2012), earn 15% more than their colleagues in the Northwest, with the lowest compensation (a mean of $162,000 in 2012).
In 2011, family physicians again earned the most in the North Central region, and earned the least in the Mid-Atlantic region.
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.
Family Physician Compensation by Setting
Unlike in Medscape's 2012 Compensation Report, where family physicians in multispecialty group practices were the top earners, this year those who work in hospitals made the most, with a mean income of $204,000. On the contrary, family physicians in multispecialty practices made $191,000 in 2012, while those in single-specialty group practices earned $178,000 in 2012.
Employed physicians earned more than those in solo practice, although partners beat them all. And those working in healthcare organizations did better in 2012 than in 2011. Family physicians in academic settings were at the bottom of the pack in 2012, with $154,000 in annual earnings, a decrease from 2011.
Do Family Physicians Feel Fairly Compensated?
Fewer family physicians feel fairly compensated (49%) than do not (51%), which is in the same range as their feelings toward the issue in prior years. In 2010, 50% felt fairly compensated. In 2011, that number was 47% -- despite the fact that family medicine is one of the lowest-paid medical specialties.
Compared with all physicians, however, family physicians feel slightly 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 all doctors to varying degrees, the number of family physicians who would choose medicine again as a career has remained strong nevertheless. Some 62% would do so in 2012 vs 64% in 2011.
However, among family physicians who said that they would opt in again, 28% would choose the same specialty in 2012, a bit lower than 2011's 32%.
On the other hand, there were ripples of discontent about practice setting. In 2012, only 20% of family physicians said that they would choose the same practice setting, compared with 25% in 2011.
Family Physician Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Family physicians saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 12% of family physicians either participated in an ACO or planned to join one in the coming year. This year saw a large jump, to 29%.
Also, very slightly more family physicians have opted for concierge medical practices in 2012 than in 2011 (3% vs 2%). The number of family physicians who are in cash-only practices stayed the same, however (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 family physicians, 15% plan to stop taking new Medicare or Medicaid patients, and 3% plan to stop seeing current Medicare or Medicaid patients. Another 29% 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. Be that as it may, more than half (53%) of family 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, 1 in 4 family physicians (25%) were planning to take this advice, or perhaps they do it already. But 19% were planning to keep all insurers because they felt that even poor payers represent revenue. Another 16% 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.
Many family physicians said yes. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was slightly higher for family physicians: 22%. Similarly, 21% of ob/gyns and 22% of dermatologists added ancillary services, as did 29% of plastic surgeons.
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, 53% of family physicians said that they regularly discuss costs with patients, and another 39% said that they occasionally discuss costs, if a patient brings it up. In 2012, fewer family physicians -- 47% -- said that they regularly discuss the cost of care with patients, and fewer -- 35% -- discuss cost if the patient brings 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 family physicians spends 30-40 hours per week seeing patients, which has remained constant. In both 2012 and 2011, 39% worked 30-40 hours per week. In the previous year, 40% 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 very similar from one year to the next. In 2012, 23% of family physicians worked less than 30 hours a week; 16% worked 41-45 hours, 10% worked 46-50 hours, and 11% worked 51 or more hours. Those percentages are about the same as those we reported for 2011.
Number of Patients per Week
The sweet spot for family physicians is 76-99 patient visits per week (22%), followed closely by 100-124 visits per week (21%). That figure has stayed consistent since 2010. Patient loads of fewer than 25 patients per week, or 150 or more, are rare in family medicine -- 9% and 7%, respectively, in 2012.
Amount of Time Spent With Each Patient
For the largest percentage of family physicians -- 36% in 2012 -- a mean of 13-16 minutes was the norm per patient visit.
That percentage represents a slight increase in the number of family physicians who saw patients for that long in recent years. In 2011, 32% of family physicians saw patients for 13-16 minutes; in 2010, that number was 30%.
About 22% of family physicians see patients for less than 13 minutes, a percentage that has remained stable over the past 3 years. The same can be said for the number who see patients for 17-20 minutes (about 24%) and for 21 minutes or longer (about 18%).
Hours Spent Seeing Patients in the Hospital
Family physicians, because of their specialty, spend very little of their time in the hospital with patients. Only 5% spend 25 hours or more per week seeing patients in the hospital. A full 68% spend less than 1 hour per week in the hospital seeing patients.
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%.
Hours Spent per Week on Paperwork and Administrative Activity
Most jobs entail paperwork and cumbersome chores. And family physicians were more bogged down with such tasks than were many other specialists.
More than 1 in 4 family physicians (28%) spent 10-14 hours on paperwork and administration each week, and another 11% spent 15-19 hours. Some 17% had 20 hours or more of paperwork per week, while an equal percentage logged just 1-4 hours.
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 family physicians, there are clearly plenty of emotional rewards that still have a strong impact.
For 31% of doctors overall, relationships with patients ranked next on the list in 2012. However, among family physicians, 44% felt the same, making it the number-one factor in career satisfaction among this group. Being good at the practice of medicine was the paramount reward for 23%; for physicians overall, that number was 34%.
Knowing that they're making the world a better place ranked third in importance, with 12% of family physicians citing it in 2012 compared with 9% of physicians overall.
When it came to the most rewarding part of their job, family physicians were just as likely as doctors overall (7%) to note "being proud of being a doctor" as the chief reward.
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