Friday, September 29, 2023
General Surgeon 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
General Surgeon Compensation in 2012
Physicians have done well in 2012, and surgeons are in the top half in the ranks. General surgeons were the 9th highest ranked specialty, with a mean income of $279,000. Topping the list were orthopedists, cardiologists, radiologists, and gastroenterologists
Historically, general surgeons have consistently ranked in the top half among the specialties in Medscape's surveys. In our 2012 report, general surgeons ranked eleventh. In our 2011 report, they ranked seventh.
Approximately 6% of general surgeons 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.
General Surgeon Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been very little movement in earnings for general surgeons. In 2012, 44% of respondents said that their compensation remained the same from the previous year, compared with 40% in 2011.
Similarly, in 2012, 24% of general surgeons said that they earned more than they earned in 2011, and 32% earned less. In 2011, 32% of surgeons earned more than they did in the previous year, and 29% 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. General surgery is near the norm; male surgeons earn about 29% more than females.
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, 29% of general surgeon 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%.
General Surgeon Compensation by Geographical Region
General surgeon compensation varies significantly by region. Doctors in the North Central region, with the highest compensation (a mean of $340,000 in 2012), earn 32% more than their colleagues in the West, with the lowest compensation (a mean of $258,000 in 2012).
In 2011, the picture looked different. General surgeons in the Great Lakes region then had the highest compensation, and those in the Northwest had the lowest.
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.
General Surgeon Compensation by Setting
In contrast to Medscape's 2012 Compensation Report, where general surgeons in multispecialty group practices ranked third in earnings (behind doctors in healthcare organizations and single-specialty groups), in our 2013 report general surgeons in multispecialty groups were the top earners, with a mean income of $338,000, higher than last year's figure of $324,000. General surgeons in single-specialty groups, who were also among the highest earners, nevertheless saw an income decline: $311,000 in 2012 vs $332,000 in 2011.
Employed physicians earned more than those in solo practice, although partners beat them all. General surgeons working in hospitals earned a mean of $262,000 in 2012, an increase from $226,000 in 2011. Those working in healthcare organizations did worse in 2012 than in 2011, losing $29,000 in earnings. General surgeons in office-based solo practices were near the bottom of the pack in 2012 with $238,000, a decrease from 2011 ($250,000).
Do General Surgeons Feel Fairly Compensated?
Only 42% of general surgeons feel that they are fairly compensated with their income, compared with 58% who feel that they are unfairly compensated. That proportion is nearly identical to the percentages reported in 2011, which saw 43% of general surgeons feeling fairly compensated.
This is lower than the percentage of physicians in all specialties who feel fairly compensated; only 48% of doctors overall are satisfied with their income.
If You Had to Do It All Over Again, Would You...
The changing healthcare environment appears to have affected general surgeons more so than other doctors, and the number of general surgeons who would choose medicine again as a career has declined. Only 41% would do so in 2012 vs 49% in 2011.
Among general surgeons who said that they would opt in again, fewer than half (47%) would choose the same specialty in 2012, identical to 2011's 47%.
There was obvious discontent about practice setting as well. In 2012, only 20% of general surgeons said that they would choose the same practice setting, similar to 21% in 2011.
General Surgeon Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. General surgeons saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 9% of general surgeons either participated in an ACO or planned to join one in the coming year. This year saw a huge jump, to 27%.
While the same amount of surgeons (2%) have opted for cash-only practices in 2012 vs 2011, more are offering concierge practice models (2% in 2012 vs <1% in 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 general surgeons, 7% plan to stop taking new Medicare or Medicaid patients, and 1% plan to stop seeing current Medicare or Medicaid patients. Another 29% 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, 63% of general surgeons 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 1 in 4 general surgeons (26%) were planning to take this advice, or perhaps they do it already. But 26% were planning to keep all insurers because they felt that even poor payers represent revenue. Another 19% 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 less compatible with surgery than they are with other specialties. The number of general surgeons who said yes is less than average for doctors overall. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage for general surgeons: 16%. By contrast, 22% of dermatologists, 19% of endocrinologists, and 29% of plastic surgeons (the 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, only 27% of general surgeons said that they regularly discuss cost with patients, although another 51% said that they occasionally discuss costs, if a patient brings it up. In 2012, fewer general surgeons -- 18% -- said that they regularly discussed the cost of care with patients, and virtually the same number -- 50% -- would discuss costs 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 general surgeons, it's likely that other personnel, such as the patient's other physician or the hospital billing staff, discuss cost of treatment with patients.
Hours Spent Seeing Patients per Week
The largest percentage of general surgeons spend 30-40 hours per week seeing patients, although the number is shrinking. In 2012, 19% saw patients for 30-40 hours per week; in 2011, it was about 23%. 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 similar from one year to the next. In 2012, 18% of general surgeons worked less than a 30-hour week (about the same as in 2011); 26% worked 41-50 hours (in 2011, 24% did); and 16% saw patients for more than 60 hours, vs 17% in 2011.
Number of Patients per Week
The sweet spot for general surgeons is 25-49 patient visits per week. In 2012, that accounted for 33% of general surgeons, about the same as in 2011 and 2010. The next-largest group -- 31% in 2012, 31% in 2011, and 30% in 2010 -- sees 50-75 patients per week. Patient loads in excess of 100 patients per week are rare in general surgery. Only 9% of general surgeons saw that many patients in 2012, the same percentage as in 2011.
Amount of Time Spent With Each Patient
Due to the nature of the specialty, general surgeons spend less time with each patient than do many other types of doctors. For the largest percentage of general surgeons -- 31% in 2012 -- a mean time of 13-16 minutes was the norm per patient visit.
In fact, the amount of time that general surgeons spend with each patient has been remarkably consistent from year to year. In 2012, 24% saw patients for 9-12 minutes (in 2011, it was 21%); 20% saw patients for 17-20 minutes (in 2011, it was 22%); and 12% saw patients for 21-24 minutes (vs 9% in 2011).
The percentage of general surgeons who saw patients for less than 9 minutes was also close: 4% in 2012, 6% in 2011. The greatest difference was in doctors who saw patients for 25 minutes or longer: 14% of general surgeons did in 2011, but only 8% did in 2012.
Hours Spent Seeing Patients in the Hospital
General surgeons, because so much of their specialty is now practiced in ambulatory surgical centers, spend a smaller portion of their time in the hospital with patients than they have in recent years. Only about 1 in 4 (24%) spends 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 general surgeons were more bogged down with such tasks than were many other specialists.
Nearly a third of general surgeons (31%) spent 10-14 hours on paperwork and administration each week, and another 23% spent 5-9 hours. About 19% had 20 hours or more of paperwork per week. Only 12% had 1-4 hours of paperwork.
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. Like surgeons, however, 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 general surgeons, there are clearly plenty of emotional rewards that still have a strong impact. In many other specialties, being good at the practice of medicine ranked number one in importance, with patient relationships often a distant second or third. Not so with general surgeons: 38% value their relationships with patients above all else.
Which is not to say that being good at the practice of medicine isn't important to general surgeons: 33% said that it was; for physicians overall, that number was nearly identical: 34%.
Good compensation ranked fourth in importance, with 7% of general surgeons citing it in 2012 compared with 9% for physicians overall.
When it came to pride in being a doctor, general surgeons in 2012 proved perfectly average: 7% cited it as the most rewarding part of the job, as did 7% of doctors overall.
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