Tuesday, October 3, 2023
Orthopedist 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
Orthopedist Compensation in 2012
Physicians have done well in 2012, and orthopedists did best of all. Orthopedists were the top-ranked specialty, with a mean income of $405,000. Also near the top were cardiologists, radiologists, gastroenterologists, and urologists.
Historically, orthopedists have ranked at or near the top among the specialties in Medscape's compensation surveys. In our 2013 report, they placed first, which was also the position they held in 2010. They placed second in 2011; radiologists ranked first that year.
About 35% of orthopedists earn $500,000 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.
Orthopedist Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been very little movement in earnings for orthopedists. In 2012, 32% of respondents said that their compensation remained the same from the previous year, compared with 34% in 2011.
Similarly, in 2012, 28% of orthopedists said that they earned more than they earned in 2011, and 38% earned less. In 2011 compared with 2010, 30% saw earnings increases and 36% experienced a 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 orthopedics, however, women outearned men in Medscape's 2013 Compensation Report.
This is an anomalous result and is partly due to the relatively few female orthopedists who took part in this year's survey: only 9%, (91% were male). In addition, the earnings for this small group were very high.
Orthopedist Compensation by Geographical Region
Orthopedist compensation varies significantly by region. Doctors in the Northwest, with the highest compensation, earn much more than their colleagues in the Mid-Atlantic region, with the lowest compensation (a mean of $248,000 in 2012).
In 2011, the spread was not as wide. Orthopedists earned the most in the West (although those in the Northwest weren't far behind) and the least in the Northeast.
Orthopedist Compensation by Setting
In Medscape's 2013 report, the highest earners were orthopedists who are partners ($480,000); then those in single-specialty group practices ($469,000), followed by doctors in healthcare organizations ($422,000) and multispecialty groups ($422,000). In Medscape's 2012 Compensation Report, orthopedists in healthcare organizations were the top earners ($427,000). In 2011, single-specialty groups ranked second in compensation ($391,000); multispecialty groups ranked third ($340,000).
Orthopedists in outpatient clinics were at the lower end in 2012 with a mean compensation of $200,000, as were orthopedists in academic settings ($304,000).
Do Orthopedists Feel Fairly Compensated?
Only 39% of orthopedists feel fairly compensated. A significant majority -- 61% -- feels underpaid. This represents a steep erosion in feelings about earnings fairness. In 2011, 50% of orthopedists felt fairly compensated. This, despite the fact that orthopedists rank first in compensation among physicians overall.
Compared with all physicians, however, a lower-than-average percentage of orthopedists feel 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...
The changing healthcare environment appears to have affected orthopedists more than other doctors, and the number who would choose medicine again as a career has significantly declined. Only 37% would do so in 2012 vs 54% in 2011.
However, among orthopedists who said that they would opt in again, 56% would choose the same specialty in 2012; in 2011, it was far fewer: 41%.
There were also ripples of discontent about practice setting. In 2012, only 21% of orthopedists said that they would choose the same practice setting, compared with 23% in 2011.
Orthopedist Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Orthopedists saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 8% of orthopedists either participated in an ACO or planned to join one in the coming year. This year saw a large jump, to 22%.
Also, very slightly more orthopedists have opted for concierge medical practices in 2012 than in 2011 (2% vs 1%). Slightly fewer orthopedists are in cash-only practices (2% 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 orthopedists, 13% plan to stop taking new Medicare or Medicaid patients, and 6% 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, 52% of orthopedists 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, 37% of orthopedists were planning to take this advice, or perhaps they do it already. But 13% were planning to keep all insurers because they felt that even poor payers represent revenue. Another 22% 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 orthopedists said yes. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was higher for orthopedists: 25%. 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, only 32% of orthopedists said that they regularly discuss costs with patients, although another 58% said that they occasionally discuss costs, if a patient brings it up. In 2012, nearly the same percentage of orthopedists -- 31% -- said that they regularly discussed the cost of care with patients, and quite a bit fewer -- 44% -- 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.
In the case of orthopedists, it's likely that other personnel, such as the hospital or office-based billing staff, discuss cost of treatment with patients.
Hours Spent Seeing Patients per Week
The largest percentage of orthopedists 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, 28% worked 30-40 hours per week. In the previous year, about 27% 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, 21% of orthopedists worked less than 30 hours per week (in 2011, it was about 23%); 8% worked 41-45 hours (in 2011, it was nearly 15%), 4% worked 51-55 hours (also about the same), and 10% worked 56-60 hours (about the same). In 2012, 4% of orthopedists saw patients for more than 60 hours per week; in 2011, only 6% did.
Number of Patients per Week
The sweet spot for orthopedists is 50-75 patient visits per week. In 2012, that accounted for 24% of orthopedists vs 22% in 2011 and about 24% in 2010. In 2012, the next largest group -- 20% -- saw 100-124 patients per week. In 2011, the next largest group saw 76-99 patients per week (about 23%). Patient loads in excess of 100 patients per week are common in orthopedics. Fully 37% of orthopedists saw that many patients in 2012, about the same percentage as in 2011.
Amount of Time Spent With Each Patient
Due to the nature of the specialty, orthopedists don't spend more time with each patient than do many other types of doctors. For the largest percentage of orthopedists -- 32% in 2012 -- a mean of 13-16 minutes was the norm per patient visit. In 2011, 30% of orthopedists saw patients for that long.
In 2012, the second most common visit time was 9-11 minutes, accounting for 30% of orthopedists, vs 32% in 2011. Also common in both years was 17-20 minutes. In 2012, 25% of orthopedists saw patients for that long -- a large increase over 2011's 16%.
About 6% of orthopedists see patients for less than 9 minutes, a percentage that has been steadily dropping. In 2010 it was 13% and in 2011 it was 10%. The percentage of orthopedists who spend 25 minutes or longer with patients was 6% in 2012 and 9% in 2011.
Hours Spent Seeing Patients in the Hospital
Orthopedists, because so much of their specialty is either office- or ambulatory surgical center-based, don't spend a large portion of their time in the hospital with patients. In 2012, 33% spent 1-4 hours per week seeing patients in the hospital.
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 orthopedists were more bogged down with such tasks than were many other specialists.
More than 1 in 4 orthopedists (26%) spent 10-14 hours on paperwork and administration each week and 13% spent 15-19 hours. About 14% spent only 1-4 hours on paperwork. On the high end, 9% of orthopedists 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 orthopedists, 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. The same percentage of orthopedists agreed, and being an excellent clinician ranked second as a factor in their career satisfaction.
Good compensation ranked fourth in importance, after pride in being a doctor, with 7% of orthopedists citing it in 2012 compared with 9% of physicians overall.
As for being proud of being a physician, the percentage of orthopedists in 2012 who cited that as their chief motivator was about the same as for doctors overall: 6% vs 7%.
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