Thursday, September 28, 2023
Nephrologist 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
Nephrologist Compensation in 2012
Physicians have done well in 2012, and nephrologists are near the middle of the ranks. Nephrologists were the 14th highest ranked specialty, with a mean income of $263,000. Topping the list were orthopedists, cardiologists, radiologists, gastroenterologists, and urologists.
Historically, nephrologists have ranked in the middle among the specialties in Medscape's surveys, although there has been a slight decline. In our 2012 report, nephrologists ranked 17th highest, while in the previous year they were 15th.
Over 12% of nephrologists earn $400,000 or more; about 11% 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.
Nephrologist Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, earnings for nephrologists have stabilized considerably. In 2012, 51% of respondents said that their compensation remained the same from the previous year, compared with 38% in 2011.
In 2012, 23% of nephrologists said that they earned more than they earned in 2011, and 26% earned less. In 2011 compared with 2010, 37% increased their income and 25% saw an earnings decline.
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 nephrology, however, that gap is 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, 29% of nephrologist 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%.
Nephrologist Compensation by Geographical Region
Nephrologist compensation varies significantly by region. Doctors in the Southwest, with the highest compensation (a mean of $289,000 in 2012), earn more than their colleagues in the Great Lakes region, with the lowest compensation (a mean of $180,000 in 2012).
In 2011, the spread was significantly wider. Nephrologists earned the most (a mean of $320,000) in the Northwest, $156,000 more than nephrologists earning the least (a mean of $164,000 in the Northeast).
Nephrologist Compensation by Setting
In Medscape's 2012 Compensation Report, nephrologists in multispecialty group practices were the top earners, with a mean income of $308,000. In our 2013 report, nephrologists in multispecialty groups earned considerably less ($259,000) and fell in the earnings ranking to fourth place, behind nephrologists who work in outpatient clinics ($300,000), office-based solo practices ($297,000), and single-specialty groups ($283,000).
In 2011, the rankings looked quite different. Nephrologists in single-specialty groups were second ($228,000) and solo practitioners ranked third ($235,000).
Nephrologists in solo practice earned more than employed physicians, although partners beat them all. Nephrologists working in hospitals earned a mean of $149,000 in 2012, a decrease from $161,000 in 2011. Those working in healthcare organizations did much better in 2012 than in 2011 (a $70,000 increase).
Do Nephrologists Feel Fairly Compensated?
Fewer than half of nephrologists feel fairly compensated vs those who believe they are underpaid (42% vs 58%), and this represents a gradual erosion in feelings about earnings fairness. In 2010, about 45% of nephrologists felt fairly compensated. In 2011, that number was 46%.
Compared with all physicians, nephrologists are more dissatisfied with their compensation than average. Among physicians overall, only 48% of doctors are satisfied with their pay.
If You Had to Do It All Over Again, Would You...
The changing healthcare environment appears to have affected nephrologists more than other doctors, and the number who would choose medicine again as a career has declined. Only 48% would do so in 2012 vs 54% in 2011.
Among nephrologists who said that they would opt in again, only 39% would choose the same specialty in 2012, almost identical to 2011's 38%.
There were also strong notes of discontent about practice setting. In 2012, only 19% of nephrologists said that they would choose the same practice setting, compared with 20% in 2011.
Nephrologist Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Nephrologists saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 12% of nephrologists either participated in an ACO or planned to join one in the coming year. This year saw a large jump, to 28%.
Also, the number of nephrologists who have opted for concierge medical practices in 2012 remains identical to 2011 (1%). The same is true of nephrologists who are in cash-only practices (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.
However, that is not the case among nephrologists. Among nephrologists, 3% 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, 70% of nephrologists 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, nearly 1 in 5 nephrologists (18%) were planning to take this advice, or perhaps they do it already. But 30% 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.
While some nephrologists are adding ancillary services, the percentage is not large. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was nearly identical for nephrologists: 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, 34% of nephrologists said that they regularly discuss costs with patients. Another 50% said that they occasionally discuss costs if a patient brings it up. Both percentages are above average for doctors overall. In 2012, fewer nephrologists -- 30% -- said that they regularly discussed 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.
In the case of nephrologists, it's likely that other personnel, such as hospital or office-based practice billing staff, discuss cost of treatment with patients.
Hours Spent Seeing Patients per Week
The largest percentage of nephrologists spends 30-40 hours per week seeing patients. The percentage of doctors who put in that amount of time has remained constant. In both 2012 and 2011, 21% worked 30-40 hours per week. In the previous year, the percentage was similar too. 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, 33% of nephrologists worked a 41- to 50-hour week (similar to 2011); 27% saw patients for 51-65 hours (about the same as in 2011), and 13% spent fewer than 30 hours a week seeing patients (in 2011, it was 15%).
There was one big difference and it was among the hardest workers. In 2011, about 13% of nephrologists saw patients for more than 65 hours per week. In 2012, only 6% did.
Number of Patients per Week
The sweet spot for nephrologists is 50-75 patient visits per week. In 2012, that accounted for 23% of nephrologists vs 22% in 2011. The next largest group -- 21% in 2012 and about 19% in 2011 -- saw 25-49 patients per week.
In 2010, the situation was quite different. Nephrologists seeing 79-99 patients ranked first (about 23%), those seeing 100-224 patients occupied second place (about 21%), and those who saw either 25-49 or 50-75 patients were tied for third at about 17% each.
Patient loads in excess of 100 patients per week are common in nephrology. Fully 34% of nephrologists saw that many patients in 2012; in 2011, it was nearly identical at about 35%.
Amount of Time Spent With Each Patient
Due to the nature of the specialty, nephrologists spend more time with each patient than do many other types of doctors, although for the largest percentage -- 34% in 2012 -- a mean of 13-16 minutes was the norm per patient visit.
However, another 21% of nephrologists saw patients for 17-20 minutes, 16% spent 21-24 minutes, and 12% spent 25 minutes or longer. Only 4% of nephrologists see patients for less than 9 minutes.
In Medscape's 2012 Compensation Report, the percentages were similar. There were slightly fewer doctors in the 13- to 16-minute category (about 27%), but the category still ranked first. There were slightly more doctors in the 17- to 20-minute category: about 27%, vs 21% in our latest report. The percentages in the other categories barely changed.
Hours Spent Seeing Patients in the Hospital
Nephrologists spend a considerable portion of their time in the hospital with patients. About 30% spend 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, and nephrologists have their fair share of it.
More than 1 in 4 nephrologists (28%) spent 5-9 hours on paperwork and administration each week, and another 26% spent 10-14 hours. At the low end, 15% spent 1-4 hours on paperwork. Going the other way, fully 19% had 20 hours or more of paperwork per week.
This is in line with some other specialists with heavy paperwork loads. 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 nephrologists, 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 36%; for physicians overall, that number was nearly identical: 34%.
For 31% of doctors overall, relationships with patients ranked next on the list in 2012, and an even greater percentage of nephrologists agreed: 34%.
Good compensation ranked nearly dead last, with only 6% of nephrologists citing it in 2012 compared with 9% for physicians overall.
When it came to pride in being a doctor, however, nephrologists in 2012 took more pride than doctors overall: 11% vs 7%.
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