Friday, September 29, 2023
Infectious Disease 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
Infectious Disease Physician Compensation in 2012
Physicians have done well in 2012, although infectious disease physicians are at the low end of the income scale. Infectious disease physicians ranked at the bottom of 25 specialties surveyed, with a mean income of $170,000. Topping the list were orthopedists, cardiologists, radiologists, and gastroenterologists.
Historically, infectious disease physicians' income has ranked low among the specialties in Medscape's surveys, and there has been a small but steady erosion in the rankings. In our 2012 report, infectious disease physicians ranked 20th, while in the previous year they were 18th.
A total of 27% of infectious disease physicians earn $250,000 or more; about 16% 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.
Infectious Disease Physician Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been very little movement in earnings for infectious disease physicians. In 2012, 51% of respondents said that their compensation remained the same from the previous year, compared with 53% in 2011.
Similarly, in 2012, 27% of infectious disease physicians said that they earned more than they earned in 2011, and 22% earned less. In 2011 compared with 2010, 30% said that they earned more; 18% reported that they earned less.
Do Men or Women Earn More?
There's still a pay gap between full-time male and female physicians, regardless of specialty, and in most specialties it's large. Not so in infectious diseases, where women have almost achieved parity in earnings. Overall, male physicians earn 30% more than their female counterparts. In infectious diseases, however, that gap is only 3%, less than in other specialties, including pediatrics.
One contributing factor involves women's choice of specialties. There are more women in some of the lower-paying specialties, which skews the overall percentages. For example, 36% of infectious disease physician survey respondents were women. In other lower-paying specialties, such as pediatrics, 53% of respondents were women. On the other hand, in orthopedics, a high-paying specialty, only 9% of survey respondents were women.
Infectious Disease Physician Compensation by Geographical Region
Infectious disease physician compensation varies significantly by region. Doctors in the Northwest, with the highest compensation earn much more than their colleagues in the South Central region, with the lowest compensation.
In 2011, there was also a wide variation. Infectious disease physicians earned the most in the South Central region and the least in the Northwest.
Infectious Disease Physician Compensation by Setting
Between 2011 and 2012, infectious disease physicians experienced changes in earnings in nearly every category. In 2012, infectious disease physicians in solo practice ranked first, with meaning earnings of $225,000; in 2011, they ranked second ($200,000). In 2011, infectious disease physicians in single-specialty groups took top earnings honors ($254,000). In 2012, they ranked fourth ($188,000).
Employed physicians earned far less than those in solo practice; even partners earned less. Infectious disease physicians working in hospitals earned a mean of $170,000 in 2012, nearly the same as in 2011 ($168,000). Those working in healthcare organizations earned even less in 2012 than in 2011 ($134,000 vs $149,000).
Do Infectious Disease Physicians Feel Fairly Compensated?
More infectious disease physicians feel unfairly compensated than the reverse (54% vs 46%), and this represents a gradual erosion in feelings about earnings fairness. In 2010, about 54% of infectious disease physicians felt fairly compensated. In 2011, that number was 52%.
It is not surprising that, compared with physicians overall, infectious disease physicians felt less satisfied (46%) with their earnings. 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 infectious disease physicians more than other doctors, the number of infectious disease physicians who would choose medicine again as a career is higher than in most specialties: 58%. However, this represents a 5-point drop from 2011, when 63% said that they would choose medicine again if they had a second chance.
Of infectious disease physicians who said that they would opt in again, the percentage of those who would choose the same specialty was also high in 2012: 54%. This is significantly higher than in 2011, when 46% said that they would choose infectious diseases a second time.
On the other hand, there was a strong degree of discontent about practice setting. In 2012, only 16% of infectious disease physicians said that they would choose the same practice setting, compared with 25% in 2011.
Infectious Disease Physician Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Infectious disease physicians saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 9% of infectious disease physicians either participated in an ACO or planned to join one in the coming year. This year saw a huge jump, to 20%.
Also, a small but significant percentage of infectious disease physicians opted for concierge medical practices in 2012 than in 2011 (3% vs 0%). The same is true of infectious disease physicians 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 infectious disease physicians, 7% plan to stop taking new Medicare or Medicaid patients, and none plan to stop seeing current Medicare or Medicaid patients. Another 27% 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, 66% of infectious disease 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, fewer than 1 in 7 infectious disease physicians (14%) were planning to take this advice, or perhaps they do it already. But 20% were planning to keep all insurers because they felt that even poor payers represent revenue. Another 27% 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 infectious disease physicians said yes. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was considerably higher for infectious disease physicians: 27%. 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, 41% of infectious disease physicians said that they regularly discuss cost with patients, and another 44% said that they occasionally discuss costs, if a patient brings it up. In 2012, fewer infectious disease physicians -- 35% -- said that they regularly discuss the cost of care with patients, and fewer -- 41% -- discuss cost only when 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 infectious disease physicians spends less than 30 hours per week seeing patients. The percentage of doctors who put in that amount of time has remained constant. In 2012, 26% of infectious disease specialists saw patients for less than 30 hours per week; in 2011, 28% did.
In 2012, 24% worked 30-40 hours per week. In the previous year, 22% 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 similar from one year to the next. In 2012, 14% of infectious disease physicians worked a 41- to 45-hour week (the same as in 2011); 14% worked 46-50 hours (about the same as in 2011), and 4% worked 51-55 hours (about half as many as in 2011). The biggest difference, however, was in doctors who saw patients for over 60 hours a week. In 2011, it was about 14%; in 2012, it was half that.
Number of Patients per Week
The sweet spot for infectious disease physicians is 25-49 patient visits per week. In 2012, that accounted for 27% of infectious disease physicians vs 24% in 2011 and 22% in 2010. The next-largest group -- 20% in 2012 -- sees 50-75 patients per week. (In 2011, the next largest group -- about 21% -- saw fewer than 25 patients per week.) Patient loads in excess of 100 patients per week are not uncommon in the specialty. About 17% of infectious disease physicians saw that many patients in 2012, although that's down from about 24% in 2011.
Amount of Time Spent With Each Patient
In general, infectious disease physicians spend more time with each patient than do many other types of doctors. For the largest percentage of infectious disease physicians -- 50% in 2012 -- a mean of 13-16 minutes was the norm per patient visit.
That percentage represents a steep rise in the number of infectious disease physicians who saw patients for that long in recent years. In 2011, 21% of infectious disease physicians saw patients for 13-16 minutes; in 2010, that number was about 22%.
About 21% of infectious disease physicians saw patients for 17-20 minutes or 25 minutes or more in 2012. Those numbers are very similar to those for 2011, when 23% saw patients for 17-20 minutes, and 22% reported spending more than 25 minutes per patient visit.
Hours Spent Seeing Patients in the Hospital
Some infectious disease physicians spend a large portion of their time in the hospital with patients, but many don't. About 34% spent 25 hours or more per week seeing patients in the hospital in 2012, while 28% see patients in the hospital for less than an hour per week.
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 infectious disease physicians were more bogged down with such tasks than were many other specialists.
More than a third of infectious disease physicians (34%) spent 10-14 hours on paperwork and administration each week, and another 35% spent even more. About 14% spent 25 or more hours a week on paperwork. Going the other way, about 15% had 1-4 hours of paperwork per week.
That's similar to the paperwork load of 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 infectious disease 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 38%; for physicians overall, that number was slightly less: 34%.
For 31% of doctors overall, relationships with patients ranked next on the list in 2012. Among infectious disease physicians, virtually the same number -- 32% -- felt the same, and it ranked second as a factor in career satisfaction.
Good compensation ranked fifth in importance, with 5% of infectious disease physicians citing it in 2012 compared with 9% for physicians overall.
When it came to pride in being a doctor, infectious disease physicians in 2012 felt a less-than-average amount of pride: 3%, vs 7% for doctors overall.
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