Friday, September 29, 2023
Ophthalmologist 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
Ophthalmologist Compensation in 2012
Physicians have done well in 2012, and ophthalmologists are no exception. Ophthalmologists are in the middle of the ranks in terms of income. Ophthalmologists were the 11th highest ranked specialty, with a mean income of $276,000. Topping the list were orthopedists, cardiologists, radiologists, gastroenterologists, and urologists.
Historically, ophthalmologists have ranked high among the specialties in Medscape's surveys, although there has been a slight decline. In our 2012 report, ophthalmologists ranked 10th highest, while in the previous year they were twelfth.
About 13% of ophthalmologists 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.
Ophthalmologist Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been very little movement in earnings for ophthalmologists. In 2012, 46% of respondents said that their compensation remained the same from the previous year, compared with 32% in 2011.
Similarly, in 2012, 29% of ophthalmologists said that they earned more than they earned in 2011, and 26% earned less. In 2011 compared with 2010, nearly a third reported earnings increases, and nearly one half saw their income 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 ophthalmology, men earn 34% more than women, which is slightly above the average for physicians overall.
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, 25% of ophthalmologist 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%.
Ophthalmologist Compensation by Geographical Region
Ophthalmologist compensation varies significantly by region. Doctors in the North Central region, with the highest compensation (a mean of $351,000 in 2012), earn much more than their colleagues in the South Central region, with the lowest compensation (a mean of $230,000 in 2012).
In 2011, the spread was not as wide. Ophthalmologists earned the most (a mean of $315,000) in the West, considerably more than ophthalmologists earning the least (a mean of $253,000 in the Southeast).
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.
Ophthalmologist Compensation by Setting
As in Medscape's 2012 Compensation Report, ophthalmologists in healthcare organizations are the top earners by work setting, with a mean income of $348,000. This is slightly lower than last year's figure of $352,000. Ophthalmologists in multispecialty groups, who ranked second, saw big gains in 2012: $340,000 vs $289,000 in 2011. Those in single-specialty groups, who are also among the highest earners, saw a hefty income decline: $292,000 in 2012 vs $327,000 in 2011.
Ophthalmologists in solo practice earned more than employed physicians, although partners beat them all. Ophthalmologists working in hospitals earned a mean of $205,000 in 2012, an increase from 2011. Ophthalmologists in academia were at the bottom of the pack in 2012 with $173,000 and saw a decrease from 2011.
Do Ophthalmologists Feel Fairly Compensated?
Fewer ophthalmologists feel fairly compensated (46%) than those who feel unfairly compensated (54%). This represents a gradual erosion in feelings about earnings fairness. In 2011, 50% of ophthalmologists felt fairly compensated. In 2011.
Compared with all physicians, however, a smaller percentage of ophthalmologists feel fairly compensated: Among all physicians, 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 ophthalmologists more than other doctors, and the number of ophthalmologists who would choose medicine again as a career has steeply declined. Only 38% would do so in 2012 vs 53% in 2011.
However, among ophthalmologists who said that they would opt in again, 61% would choose the same specialty in 2012, close to 2011's 58%.
On the other hand, there were ripples of discontent about practice setting. In 2012, only 26% of ophthalmologists said that they would choose the same practice setting, compared with 29% in 2011.
Ophthalmologist Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Ophthalmologists saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 7% of ophthalmologists either participated in an ACO or planned to join one in the coming year. This year that percentage doubled to 14%.
Also, very slightly more ophthalmologists have opted for concierge medical practices in 2012 than in 2011 (3% vs 1%). The same is true of ophthalmologists who are in cash-only practices (4% vs 3%).
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 ophthalmologists, 7% plan to stop taking new Medicare or Medicaid patients, and 2% plan to stop seeing current Medicare or Medicaid patients. Another 30% 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, 61% of ophthalmologists 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, 42% of ophthalmologists 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 12% 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.
The number of ophthalmologists who said yes is about the same as for doctors overall. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was only 1 point higher for ophthalmologists: 20%. 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 45% of ophthalmologists said that they regularly discuss costs with patients -- although this was well above average for doctors overall -- and another 45% said that they occasionally discuss costs, if a patient brings it up. In 2012, even fewer ophthalmologists -- 39% -- said that they regularly discussed the cost of care with patients, and fewer -- 42% -- 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 ophthalmologists spends 30-40 hours per week seeing patients. The percentage of ophthalmologists who put in that amount of time has remained constant. In 2012, 40% saw patients for 30-40 hours per week; in 2011, it was 39%. In 2010, just under 45% 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, 18% of ophthalmologists spent less than 30 hours per week seeing patients (in 2011, it was 14%), 18% worked 41-45 hours (in 2011, it was about 23%), 12% worked 46-50 hours (about the same as in 2011), and 2% saw patients for more than 60 hours (in 2011, it was about 3%).
Number of Patients per Week
The sweet spot for ophthalmologists is 100-124 patient visits per week. In 2012, that accounted for 19% of ophthalmologists vs 21% in 2011 and nearly 25% in 2010. In 2012, the next largest group --15% -- saw 125-149 patients per week. In 2011, the next largest group -- about 17% -- saw 76-99 patients per week.
However, the percentages for each category are similar from one year to the next. Patient loads in excess of 100 patients per week are common in ophthalmology. Fully 54% of ophthalmologists saw that many patients in 2012, down from about 60% in 2011.
Amount of Time Spent With Each Patient
Due to the nature of the specialty, ophthalmologists spend less time with each patient than do many other types of doctors. For the largest percentage of ophthalmologists -- 37% in 2012 -- a mean of 9-12 minutes was the norm per patient visit.
That percentage is in line with the number of ophthalmologists who saw patients for that long in recent years. In 2011, about 36% of ophthalmologists saw patients for 9-12 minutes; in 2010, that number was about 43%.
About 27% of ophthalmologists see patients for 13-16 minutes, a percentage that has remained stable over the past 3 years. The number of ophthalmologists who see patients for less than 9 minutes was 17% in 2012 and 15% in 2011. Going the other way, 5% of ophthalmologists saw patients for 25 minutes or longer in 2012; 4% did in 2011.
Hours Spent Seeing Patients in the Hospital
Ophthalmologists, because of their specialty, don't spend a large portion of their time in the hospital with patients; 61% spend less than an hour 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 ophthalmologists were less bogged down with such tasks than were many other specialists.
More than a third of ophthalmologists (36%) spent 5-9 hours on paperwork and administration each week, and another 26% spent only 1-4 hours. Only 3% had 25 or more hours of paperwork per week.
That's in stark contrast to some of 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 ophthalmologists, there are clearly plenty of emotional rewards that still have a strong impact. Having good relationships with patients was the paramount reward for 41%; 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 ophthalmologists felt the same; being an excellent clinician ranked second as a factor in their career satisfaction.
Good compensation ranked fourth in importance, with 8% of ophthalmologists citing it in 2012 compared with 9% of physicians overall.
As for being proud of being a doctor, the percentage of ophthalmologists in 2012 who cited pride in being a physician as a reward was slightly less than that of doctors overall: 5% vs 7%.
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