Tuesday, March 21, 2023
Internist 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? Close to 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.
Internist Compensation in 2012
Physicians have done well in 2012, and internists have seen an increase in earnings. As far as compensation, internists are in the lower third of the ranks. Internists had a mean income of $185,000. Topping the list were orthopedists, cardiologists, radiologists, and gastroenterologists.
Historically, internal medicine has been among the lower earning of the medical specialties. In both of Medscape's previous compensation surveys, internists placed in the bottom third of specialists.
About 10% of internists earn $300,000 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.
Internist Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been moderate movement in earnings for internists. In 2012, 50% of respondents said that their compensation remained the same from the previous year, compared with 42% in 2011.
Similarly, in 2012, 29% of internists said that they earned more than they earned in 2011, and 20% earned less. In 2011 compared with 2010, 37% increased their compensation and 21% reported income declines.
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 internal medicine, however, that gap is 18%, 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, such as orthopedics (9% of survey respondents were women) which skews the overall percentages. For example, 29% of internist survey respondents were women; in pediatrics, 53% of respondents were women; for family medicine, it was 36%.
Internist Compensation by Geographical Region
Internist compensation varies by region, but not as significantly as in other specialties. Doctors in the South Central region, with the highest compensation (a mean of $210,000 in 2012), earn 25% more than their colleagues in the Northeast, with the lowest compensation (a mean of $168,000 in 2012).
In 2011, the spread was not as wide. Internists earned the most (a mean of $189,000) in the South Central region and the least (a mean of $151,000) in the Northeast.
Internist Compensation by Setting
As in Medscape's 2012 Compensation Report, internists in multispecialty group practices are the top earners, with a mean income of $203,000. This is somewhat lower than last year's figure of $194,000. Internists in single-specialty groups, who are also among the highest earners, saw their incomes significantly increase: $196,000 in 2012 vs $172,000 in 2011.
Employed physicians earned virtually the same as those in solo practice, although partners beat them all. Internists working in hospitals earned a mean of $192,000 in 2012, an increase from 2011. Those working in healthcare organizations also did somewhat better in 2012 than in 2011. Internists in office-based solo practices were near the lower end of the scale in 2012 with $173,000, less than they earned in 2011 ($183,000).
Do Internists Feel Fairly Compensated?
More internists feel that they are not fairly compensated (52%) than those who feel well paid (48%), but this represents a gradual improvement in feelings about earnings fairness. In 2010, only about 40% of internists felt fairly compensated. In 2011, that number was 45%.
Compared with all physicians, however, internists are perfectly average in their feelings about compensation: 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 internists more than other doctors, the number of internists who would choose medicine again as a career is high compared with doctors in other specialties. Fully 66% would do so in 2012 vs 61% in 2011.
However, among internists who said that they would opt in again, only 19% would choose the same specialty in 2012, even less than 2011's 25%.
There were also consistent indications of discontent about practice setting. In 2012, only 19% of internists said that they would choose the same practice setting, which was similar although very slightly higher than the 17% reported in 2011.
Internist Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Internists saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 13% of internists either participated in an ACO or planned to join one in the coming year. This year saw a large jump, to 29%.
Also, slightly more internists have opted for concierge medical practices in 2012 than in 2011 (4% vs 2%). The same is true of internists who are in cash-only practices (3% vs 2%).
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 internists, 11% plan to stop taking new Medicare or Medicaid patients, and 2% plan to stop seeing current Medicare or Medicaid patients. Another 32% are undecided.
That number (who will stop taking new Medicare or Medicaid patients) is somewhat higher for the primary care specialties (in family medicine, 15% of doctors plan to stop seeing current or taking new Medicare or Medicaid patients). Be that as it may, 55% of internists 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 5 internists (22%) were planning to take this advice, or perhaps they do it already. But 18% were planning to keep all insurers because they felt that even poor payers represent revenue. Another 17% 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 slightly above-average number of internists said yes. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was nearly the same for internists: 20%. 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, 38% of internists said that they regularly discuss cost with patients, although another 46% said that they occasionally discuss costs, if a patient brings it up. In 2012, even fewer internists -- 32% -- said that they regularly discussed the cost of care with patients, and somewhat fewer -- 40% -- 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.
Hours Spent Seeing Patients per Week
The largest percentage of internists spends 30-40 hours per week seeing patients. The percentage of doctors who put in that amount of time has remained remarkably constant. In 2012, 2011, and 2010, 29% worked 30-40 hours per week. 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 most categories. In 2012, 19% of internists saw patients for less than 30 hours per week (in 2011, it was 17%); 16% worked 41-45 hours (about the same as in 2011), 12% worked 46-50 hours (in 2011, it was about 13%), and 8% worked over 60 hours (in 2011, it was 14%).
Number of Patients per Week
The sweet spot for internists is 50-75 patient visits per week. In 2012, that accounted for 22% of internists vs 23% in 2011 and 22% in 2010. The next largest group -- 19% in 2012, 19% in 2011, and 22% in 2010 -- sees 76-99 patients per week. Patient loads in excess of 100 patients per week are common in internal medicine. Fully 27% of internists saw that many patients in 2012, down from about 30% in 2011.
Amount of Time Spent With Each Patient
Due to the nature of the specialty, internists spend more time with each patient than do many other types of doctors. For the largest percentage of internists -- 29% in 2012 -- a mean of 13-16 minutes was the norm per patient visit.
That percentage has remained virtually the same over recent years. In 2011, 28% of internists saw patients for 13-16 minutes; in 2010, that number was also 28%.
However, the number of internists who see patients for longer periods of time is more substantial than in many other specialties. In 2012, 27% saw patients for 17-20 minutes (it was 26% in 2011); 14% saw patients for 21-24 minutes (it was 12% in 2011); and 15% saw patients for 25 minutes or longer (it was 17% in 2011).
Hours Spent Seeing Patients in the Hospital
Internists once spent a large portion of their time in the hospital with patients. Now a dwindling number do. Only 29% spend 25 hours or more per week seeing patients in the hospital, whereas 41% spend less than an hour rounding 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 family physicians it was only 5%.
Hours Spent per Week on Paperwork and Administrative Activity
Most jobs entail paperwork and cumbersome chores. Internists had their fair share of being bogged down with such tasks.
More than half of internists (52%) spent 5-14 hours on paperwork and administration each week, and another 30% spent 15 or more hours. About 18% spent 1-4 hours on paperwork per week.
That's in line with the hours put in by some other specialists with plenty of paperwork. 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 internists, there are clearly plenty of emotional rewards that still have a strong impact. Having good relationships with patients was the paramount reward for 34%; for physicians overall, that number was 31%.
For 34% of doctors overall, being good at the practice of medicine ranked first on the list in 2012. About 31% of internists felt the same; being an excellent clinician ranked second as a factor in their career satisfaction.
Good compensation ranked fifth in importance, with 8% of internists citing it in 2012 compared with 9% for physicians overall.
When it came to pride in being a doctor, a greater percentage of internists than doctors overall named pride in being a doctor as their top reward: 9% vs 7%.
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