Tuesday, September 26, 2023
Gastroenterologist 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
Gastroenterologist Compensation in 2012
Physicians have done well in 2012, and gastroenterologists are near the top of the ranks. Gastroenterologists were the fourth highest ranked specialty, with a mean income of $342,000. Placing ahead of them in income rank were orthopedists, cardiologists, and radiologists.
Historically, gastroenterologists have ranked high among the specialties in Medscape's surveys, but they have risen in the ranks since last year's survey report. In our 2012 report, gastroenterologists ranked sixth highest, just as they were in the previous year.
About 19% of gastroenterologists 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.
Gastroenterologist Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been some movement in earnings for gastroenterologists in income stability. In 2012, 47% of respondents said that their compensation remained the same from the previous year, compared with 39% in 2011.
However, when it came to whether gastroenterologists earned more or less than in the previous year, there wasn't much average movement. In 2012, 25% of gastroenterologists said that they earned more than they earned in 2011, and 28% earned less; in 2011, 28% earned more than in 2010 and 32% earned less.
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 gastroenterology, however, that gap is about 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, 16% of gastroenterologist 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%.
Gastroenterologist Compensation by Geographical Region
Gastroenterologist compensation varies significantly by region. Doctors in the Northwest, with the highest compensation (a mean of $498,000 in 2012), earn more than their colleagues in the Mid-Atlantic region, with the lowest compensation (a mean of $311,000 in 2012).
In 2011, there was also a wide spread. Again, gastroenterologists earned the most in the Northwest, and those in the North Central region earned the least.
Gastroenterologist Compensation by Setting
In many specialties, doctors in multispecialty groups earn the most. Not so in gastroenterology. Gastroenterologists in healthcare organizations took top honors in Medscape's 2013 Compensation Report, with a mean income of $434,000. In last year's report, the number-one ranking went to gastroenterologists in single-specialty groups.
This is not to suggest that gastroenterologists in multispecialty groups don't do well. In 2012, they ranked second in earnings, with a mean compensation of $421,000. This is in marked contrast to 2011, when doctors in multispecialty groups ranked fourth, with a mean compensation of $311,000.
Solo practitioners earned more than employed physicians, although partners beat them all. Gastroenterologists working in hospitals earned a mean of $264,000 in 2012, an increase from $205,000 in 2011 but still less than in other practice situations. Those working in solo practice ranked fourth in 2012 ($340,000); in 2011, they ranked third ($323,000).
Do Gastroenterologists Feel Fairly Compensated?
A majority of gastroenterologists are not satisfied with their compensation, with 52% feeling that they are underpaid. This represents a general consistency in feelings about earnings fairness. In 2010, just over 50% of gastroenterologists felt fairly compensated. In 2011, that number was virtually the same: 51%.
Compared with physicians overall, however, gastroenterologists are basically in line. Among all physicians, only 48% of doctors are satisfied with their pay, the same as gastroenterologists.
If You Had to Do It All Over Again, Would You...
The changing healthcare environment appears to have affected gastroenterologists more than other doctors, and the number of gastroenterologists who would choose medicine again as a career has steeply declined: Only 44% would do so in 2012 vs 58% in 2011.
However, among gastroenterologists who said that they would opt in again, 58% would choose the same specialty in 2012, an increase over 2011's 51%.
On the other hand, there was consistent discontent about practice setting. In 2012, only 20% of gastroenterologists said that they would choose the same practice setting, compared with 23% in 2011.
Gastroenterologist Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Gastroenterologists saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 11% of gastroenterologists either participated in an ACO or planned to join one in the coming year. This year saw a large jump, to 26%.
Also, more gastroenterologists have opted for concierge medical practices in 2012 than in 2011 (3% vs 1%), although their numbers are still not large. The same is true of gastroenterologists who are in cash-only practices (4% vs 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 gastroenterologists, 9% plan to stop taking new Medicare or Medicaid patients, and 3% plan to stop seeing current Medicare or Medicaid patients. Another 30% 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, 58% of gastroenterologists 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 gastroenterologists (29%) were planning to take this advice, or perhaps they do it already. But 22% 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.
A great many gastroenterologists said yes. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was considerably higher for gastroenterologists: 26%. 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, 36% of gastroenterologists said that they regularly discuss cost with patients, although another 54% said that they occasionally discuss costs, if a patient brings it up. In 2012, even fewer gastroenterologists -- 28% -- said that they regularly discussed the cost of care with patients, although about 50% -- nearly the same number as in 2011 -- 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 gastroenterologists, it's likely that other personnel, such as the group practice billing staff, discuss cost of treatment with patients.
Hours Spent Seeing Patients per Week
In 2012, most gastroenterologists saw patients within 3 ranges of time per week: 30-40 hours (21%), 41-45 hours (18%), and 46-50 hours (20%).The percentage of doctors who put in that amount of time has remained constant. In 2011, 23% saw patients for 30-40 hours per week, 20% saw patients for 41-45 hours, and 18% saw patients for 46-50 hours.
Along the majority of the time continuum, the number of hours spent seeing patients was similar from one year to the next. For example, gastroenterologists working the least -- seeing fewer than 30 patients per week -- accounted for 11% of the total in 2012 and 14% in 2011. Conversely, 10% of gastroenterologists saw patients for more than 60 hours per week in 2012 vs 13% in 2011.
Number of Patients per Week
The sweet spot for gastroenterologists is 50-75 patient visits per week. In 2012, that accounted for 27% of gastroenterologists vs 24% in 2011 and nearly 30% in 2010. The next largest group -- 23% in 2012 and about 23% in 2011 -- sees 25-49 patients per week. Patient loads in excess of 100 patients per week are fairly common in gastroenterology. About 21% of gastroenterologists saw that many patients in 2012; that's roughly the same as in 2011.
Amount of Time Spent With Each Patient
Due to the nature of the specialty, gastroenterologists spend more time with each patient than do many other types of doctors. For the largest percentage of gastroenterologists -- 25% in 2012 -- a mean of 17-20 minutes was the norm per patient visit.
That percentage and all others for these time ranges are similar to 2011 results. In that year, 27% of gastroenterologists saw patients for 17-20 minutes. About 24% of gastroenterologists saw patients for 13-16 minutes in 2012, the next most common time period; in 2011 it was 23%.
About 4% of gastroenterologists see patients for less than 9 minutes, a percentage that has remained stable over the past 3 years. The percentage of gastroenterologists who see patients for 25 minutes or longer has also remained constant. In 2010 it was 18%, in 2011 it was 15%, and in 2012 it was 15%.
Hours Spent Seeing Patients in the Hospital
Gastroenterologists, because so much of their specialty is outpatient-based, spend relatively little time in the hospital with patients. About 12% spend 25 hours or more per week seeing patients in the hospital.
Other specialists spent considerably more time seeing patients in the hospital. For example, 24% of cardiologists, 29% of internists, and 72% of critical care physicians spent more than 25 hours a week in the hospital. Among family physicians, the number was only 5%.
Hours Spent per Week on Paperwork and Administrative Activity
Most jobs entail paperwork and cumbersome chores. Gastroenterologists were also bogged down with such tasks.
Fewer than 1 in 5 gastroenterologists (17%) spent 1-4 hours on paperwork and administration each week, and another 29% spent 5-9 hours. Only 12% had 20 hours or more of paperwork per week.
In contrast, the same number of family physicians -- 17% -- spend 1-4 hours on paperwork a week; but on the high end, 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 gastroenterologists, 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 39%; for physicians overall, that number was pretty close: 34%.
For 31% of doctors overall, relationships with patients ranked next on the list in 2012. Among gastroenterologists, 28% felt the same.
Even though most gastroenterologists feel underpaid, good compensation ranked only third in importance, and even that was a tie with a desire to make the world a better place. About 10% of gastroenterologists citied each in 2012, compared with 9% and 12%, respectively, for physicians overall.
When it came to pride in being a doctor, gastroenterologists in 2012 took an average amount of pride. It was cited by 8% of gastroenterologists vs 7% for doctors overall.
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