Friday, September 29, 2023
Oncologist 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
Oncologist Compensation in 2012
Physicians have done well in 2012, and oncologists are near the top of the ranks. Oncologists were the 10th highest ranked specialty, with a mean income of $278,000. Topping the list were orthopedists, cardiologists, radiologists, gastroenterologists, and urologists.
Historically, oncologists have ranked fairly high among the specialties in Medscape's surveys, although there has been a slight decline. In our 2012 report, oncologists ranked seventh highest, while in the previous year they were in ninth place.
About 10% of oncologists earn $500,000 or more; about 14% 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.
Oncologist Compensation in 2012 vs 2011
From 2011 to 2012, there was little movement in earnings for oncologists. In both years, 46% said that their compensation remained the same.
Similarly, in 2012, 25% of oncologists said that they earned more than they earned in 2011, and 28% earned less -- nearly identical to the earnings situation in 2011 compared with 2010.
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 oncology, however, men earn 22% more than women, a smaller gap 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, 28% of oncologist 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%.
Oncologist Compensation by Geographical Region
Oncologist compensation varies significantly by region. Doctors in the Southwest, with the highest compensation (a mean of $347,000 in 2012), earn far more than their colleagues in the Northeast, with the lowest compensation (a mean of $230,000 in 2012).
In 2011, oncologists also earned the most in the Southwest and the least in the Northeast.
Oncologist Compensation by Setting
As in Medscape's 2012 Compensation Report, oncologists in multispecialty group practices are the top earners, with a mean income of $356,000. This is a slight improvement over last year's figure of $347,000. Oncologists in single-specialty groups, who are also among the highest earners, saw a very slight increase in compensation: $340,000 in 2012 vs $338,000 in 2011.
Oncologists in solo practice earned more than employed colleagues, although partners beat them all. Oncologists working in hospitals earned a mean of $227,000 in 2012, an increase from $190,000 in 2011. Those working in healthcare organizations did better in 2012 than in 2011. Oncologists in academia were at the lower end of the pack in 2012 with $196,000 but saw a large increase from 2011.
Do Oncologists Feel Fairly Compensated?
More oncologists feel fairly compensated than not (51% vs 49%), but this represents a gradual erosion in feelings about earnings fairness. In 2010, about 55% of oncologists felt fairly compensated. In 2011, that number was 53% -- despite the fact that oncology is one of the higher-paying medical specialties.
Compared with all physicians, however, oncologists feel more fairly compensated: 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 oncologists as it has other doctors, more than half of oncologists (51%) would choose medicine again as a career. Only 47% would do so in 2012 vs 76% in 2011.
Among oncologists who said that they would opt in again, 57% would choose the same specialty in 2012, compared with 2011's 49%.
On the other hand, while the number of oncologists who would choose the same practice setting has improved, there were still ripples of discontent. In 2012, only 24% of oncologists said that they would choose the same practice setting, compared with 19% in 2011.
Oncologist Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Oncologists saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 9% of oncologists either participated in an ACO or planned to join one in the coming year. This year saw a huge jump, to 29%.
Concierge medical practices and cash-only practices are still very small factors in oncology. Still, very slightly more oncologists have opted for concierge medical practices in 2012 than in 2011 (2% vs 1%). The same is true of oncologists who are in cash-only practices (3% 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 oncologists, 7% plan to stop taking new Medicare or Medicaid patients, and 2% 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, 64% of oncologists 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 oncologists (23%) 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 26% 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 relatively small percentage of oncologists said yes. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was about the same for oncologists: 17%. 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 2012, only 28% of oncologists said that they regularly discuss cost with patients, although another 48% said that they occasionally discuss costs, if a patient brings it up. In 2011, more oncologists -- 33% -- said that they regularly discussed the cost of care with patients, and slightly more -- 50% -- would discuss cost if the patient brought it up.
In contrast, among all doctors, 30% regularly discussed the cost of treatment with patients in 2011, 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 oncologists spends 30-40 hours per week seeing patients. The percentage of doctors who put in that amount of time has remained constant. In 2012, 25% worked 30-40 hours per week; in 2011, 26% did. In the previous year, roughly 30% 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. For example, 15% of oncologists saw patients for less than 30 hours per week in 2012; in 2011, it was 16%. At the other extreme, 8% of oncologists saw patients for more than 60 hours or 2012; in 2011, it was about 9%.
Number of Patients per Week
The sweet spot for oncologists is 50-75 patient visits per week. In 2012 and 2011, that accounted for 26% of oncologists vs nearly 30% in 2010. The next-largest group -- 25% in 2012, about 23% in 2011, and about 23% in 2010 -- sees 25-49 patients per week. Patient loads in excess of 100 patients per week aren't unusual in oncology. Fully 18% of oncologists saw that many patients in 2012, although that was down from about 24% in 2011.
Amount of Time Spent With Each Patient
Due to the nature of the specialty, oncologists spend a considerable amount of time with each patient. For the largest percentage of oncologists -- 32% in 2012 -- a mean of 17-20 minutes was the norm per patient visit.
However, that percentage represents a slight increase in the number of oncologists who saw patients for that long in recent years. In 2011, 28% of oncologists saw patients for 17-20 minutes; in 2010, it was about 23%.
About 13% of oncologists see patients for 21-24 minutes (in 2011 it was 14%), and 14% see patients for 25 minutes or more (in 2011 it was 19%). The percentage of oncologists who see patients for fewer than 9 minutes remained unchanged in 2011 and 2012: about 3%.
Hours Spent Seeing Patients in the Hospital
Oncologists spend a decent amount of time in the hospital with patients. About 8% spend 25 hours or more per week seeing patients in the hospital, while 55% of oncologists spend 1-9 hours per week in the hospital seeing patients.
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 oncologists have their fair share of it, more so than many other specialists.
Nearly a third of oncologists (32%) spent 10-14 hours on paperwork and administration each week, and another 24% spent 5-9 hours. At the low end, about 10% spent 1-4 hours. Going the other way, about 20% had 20 hours or more of paperwork per week.
That's more than most 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. But only 12% of emergency medicine physicians had 20 hours of more of paperwork per week. For gastroenterologists, it was also 12%.
The Most Rewarding Part of Your Job
No matter what the public thinks, it's not all about the money. For oncologists, there are clearly plenty of emotional rewards that still have a strong impact. Having good relationships with patients was the paramount reward for 38%; 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 28% of oncologists felt the same; being an excellent clinician ranked second as a factor in their career satisfaction.
Good compensation ranked fifth in importance, with 7% of oncologists citing it in 2012 compared with 9% for physicians overall.
When it came to being proud of being a physician, 9% noted "pride in being a good doctor" as their number-one reward, compared with 7% of doctors overall.
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