Friday, September 29, 2023
Plastic Surgeon 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
Plastic Surgeon Compensation in 2012
Physicians have done well in 2012, and plastic surgeons are near the top of the ranks. Plastic surgeons were the seventh highest ranked specialty, with a mean income of $317,000. Topping the list were orthopedists, cardiologists, radiologists, gastroenterologists, and urologists.
Historically, plastic surgeons have ranked high among the specialties in Medscape's surveys and have made a steady climb up the ladder. In our 2012 report, plastic surgeons ranked ninth highest, while in the previous year they were tenth.
About 14% of plastic surgeons 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.
Plastic Surgeon Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been some movement in earnings for plastic surgeons. In 2012, 37% of respondents said that their compensation remained the same from the previous year, compared with 31% in 2011.
On the other hand, in 2012, 25% of plastic surgeons said that they earned more than they earned in 2011, and 37% earned less. That's somewhat of a reversal from 2011 compared with 2010, when 42% of plastic surgeons said that their income increased and only 27% said that it declined.
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 plastic surgery, however, that gap is 38.5%, more 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, only 15% of plastic surgeon survey respondents and 23% of anesthesiologist 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%.
Plastic Surgeon Compensation by Geographical Region
Plastic surgeon compensation varies significantly by region. Doctors in the Northwest region, with the highest compensation, earn more than their colleagues in the Southeast, with the lowest compensation.
In 2011, the spread was similarly wide. Plastic surgeons earned the most in the Southwest region, more than plastic surgeons earning the least, in the Southeast.
Plastic Surgeon Compensation by Setting
As in Medscape's 2012 Compensation Report, plastic surgeons in multispecialty group practices are the top earners, with a mean income of $493,000. Plastic surgeons working in healthcare organizations were the second highest earning group, at $355,000.
Solo practitioners earned more than employed physicians, although partners beat them all. Plastic surgeons working in hospitals earned a mean of $261,000 in 2012. Those working in healthcare organizations also did much better in 2012 than in 2011. Plastic surgeons in academic work settings were at the lower end of the pack in 2012 with $255,000.
Do Plastic Surgeons Feel Fairly Compensated?
Fewer plastic surgeons feel fairly compensated than not (41% vs 59%), and this represents a gradual erosion in feelings about earnings fairness. In 2010, 50% of plastic surgeons felt fairly compensated. In 2011, that number was 37%, closer to this year's number, despite the fact that plastic surgery is one of the higher-paying medical specialties.
Compared with all physicians, plastic surgeons feel less fairly compensated: Among all physicians, 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 all doctors to varying degrees, the number of plastic surgeons who would choose medicine again as a career has stayed the same: 35% in 2012 and 2011.
However, among plastic surgeons who said that they would opt in again, 58% would choose the same specialty in 2012, up from 2011's 50%.
There was consistent discontent about practice setting. In 2012, only 22% of plastic surgeons said that they would choose the same practice setting, compared with 18% in 2011.
Plastic Surgeon Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Plastic surgeons saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 6% of plastic surgeons either participated in an ACO or planned to join one in the coming year. This year saw an increase to 13%.
Also, many more plastic surgeons have opted for concierge medical practices in 2012 than in 2011 (6% vs 1%). The same is true of plastic surgeons who are in cash-only practices (33% vs 16%).
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 plastic surgeons, 19% plan to stop taking new Medicare or Medicaid patients, and 9% plan to stop seeing current Medicare or Medicaid patients. Another 26% are undecided.
That number (who will stop taking new Medicare or Medicaid patients) is somewhat lower for the primary care specialties of internal medicine (11%) and family medicine (15%). Be that as it may, 46% of plastic surgeons 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 2 in 5 plastic surgeons (44%) were planning to take this advice, or perhaps they do it already. But 19% 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 great many plastic surgeons said yes. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was considerably higher for plastic surgeons: 29%. That's second only to anesthesiologists in terms of adding 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, more than half (51%) of plastic surgeons said that they regularly discuss cost with patients, and another 37% said that they occasionally discuss costs, if a patient brings it up. In 2012, even more plastic surgeons -- 58% -- said that they regularly discussed the cost of care with patients, although fewer -- 29% -- discuss cost only if 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.
Hours Spent Seeing Patients per Week
The largest percentage of plastic surgeons (28%) spends 30-40 hours per week seeing patients. In the previous year, around 33% 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 varied considerably from one year to the next. In 2012, 23% of plastic surgeons worked a 41- to 45-hour week (it was 15% in 2011); 6% worked 46-50 hours (12% in 2011), 6% worked 51-55 hours (3% in 2011), and 13% worked 56 or more hours (in 2011, it was about 18%). In both surveys, about 21% of plastic surgeons spent less than 30 hours a week seeing patients.
Number of Patients per Week
The sweet spot for plastic surgeons is 50-75 patient visits per week. In 2012, that accounted for 33% of plastic surgeons, the same percentage as in 2010 and higher than 2011's 24%. The next largest group -- 27% in 2012, 25% in 2011, and about 30% in 2010 -- sees 25-49 patients per week. Patient loads in excess of 100 patients per week are rare in plastic surgery. Only 14% of plastic surgeons saw that many patients in 2012, although that's up sharply from 6% in 2011 and 9% in 2010.
Amount of Time Spent With Each Patient
Due to the nature of the specialty, plastic surgeons spend more time with each patient than do many other types of doctors. For the largest percentage of plastic surgeons -- 25% in 2012 -- a mean of 17-20 minutes was the norm per patient visit.
That percentage represents relative stability in recent years in the number of plastic surgeons who saw patients for that long. In 2011, 22% of plastic surgeons saw patients for 17-20 minutes; in 2010, that number was 25%.
About 28% of plastic surgeons see patients for less than 13 minutes, a percentage that has remained more or less the same over the past 3 years. But the number of plastic surgeons who see patients for 21 minutes or longer has shrunk in the past few years: In 2012, it was 22%; in 2011, it was 33%, and in 2010, almost 35%.
Hours Spent Seeing Patients in the Hospital
Plastic surgeons, because of their specialty, spend very little of their time in the hospital with patients. Only 3% spend 25 hours or more per week seeing patients in the hospital. The norm is 1-4 hours.
By contrast, 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 plastic surgeons were less bogged down with such tasks than were many other specialists.
One in 7 plastic surgeons (15%) spent 1-4 hours on paperwork and administration each week, and another 22% spent 5-9 hours. Only 12% had 20 hours or more of paperwork per week.
That's pretty close to the load for family physicians: 17% had 1-4 hours of paperwork a week, 26% had 5-9 hours, and another 17% had 20 hours or more.
The Most Rewarding Part of Your Job
No matter what the public thinks, it's not all about the money. For plastic surgeons, there are clearly plenty of emotional rewards that still have a strong impact. For 37% of plastic surgeons, the relationship with patients was the paramount reward; that factor was named by 31% of doctors overall.
Being good at the practice of medicine was the paramount reward for 26% of plastic surgeons; for physicians overall, the number was 34%
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