Thursday, September 28, 2023
Pulmonologist 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? Close to 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
Pulmonologist Compensation in 2012
Physicians have done well in 2012, and pulmonologists are no exception. Pulmonologists had a mean income of $263,000, placing them in a tie with nephrologists but trailing critical care specialists. Topping the list were orthopedists, cardiologists, radiologists, gastroenterologists, and urologists.
Historically, pulmonologists have ranked toward the middle of the pack among the specialties in Medscape's surveys, although there has been a slight decline. In our 2012 report, pulmonologists ranked 14th highest, while in the previous year they were 12th.
About 16% of pulmonologists earn $400,000 or more; about 8% 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.
Pulmonologist Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been some movement in earnings for pulmonologists. In 2012, 48% of respondents said that their compensation remained the same from the previous year, compared with 38% in 2011.
In 2012, 26% of pulmonologists said that they earned more than they earned in 2011, and 26% earned less. In 2011 compared with 2010, 26% reported increased income, while 36% said that their earnings had 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 pulmonology, however, that gap is reversed in that women earn nearly 24% more than their male colleagues.
Yet in most cases where female physicians earn less than males, 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, 23% of anesthesiologist 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%.
Pulmonologist Compensation by Geographical Region
Pulmonologist compensation varies by region. Doctors in the West region, with the highest compensation (a mean of $296,000 in 2012), earn 41% more -- $86,000 -- than their colleagues in the Southwest, with the lowest compensation (a mean of $210,000 in 2012).
In 2011, the spread was much wider. Pulmonologists earned the most (a mean of $328,000) in the South Central region, $226,000 (222%) more than pulmonologists earning the least (a mean of $102,000 in the North Central region).
Pulmonologist Compensation by Setting
As in Medscape's 2012 Compensation Report, pulmonologists in multispecialty group practices are the top earners, with a mean income of $303,000. This is somewhat higher than last year's figure of $284,000. Pulmonologists in single-specialty groups, who are also among the highest earners, saw an increase too: $299,000 in 2012 vs $274,000 in 2011.
Solo practitioners earned more than employed physicians, although partners beat them all. Pulmonologists working in academic settings earned a mean of $212,000 in 2012, a strong increase from $164,000 in 2011. Those working in healthcare organizations did slightly better in 2012 than in 2011. Pulmonologists in hospital-based practices were at the bottom of the pack in 2012 with $210,000 but saw a large increase from 2011 ($174,000).
Do Pulmonologists Feel Fairly Compensated?
Fewer pulmonologists feel fairly compensated than not (44% vs 56%), which represents a gradual erosion in feelings about earnings fairness. In 2010, 50% of pulmonologists felt fairly compensated. In 2011, that number was 47%.
Compared with all physicians, pulmonologists 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...
Perhaps because the changing healthcare environment appears to have affected pulmonologists less so than other doctors, the number of pulmonologists who would choose medicine again as a career has remained steady. Some 59% would do so in 2012 vs 60% in 2011.
Among pulmonologists who said that they would opt in again, 39% would choose the same specialty in 2012, a bit higher than 2011's 35%.
On the other hand, there were ripples of discontent about practice setting. In 2012, only 16% of pulmonologists said that they would choose the same practice setting, compared with 20% in 2011.
Pulmonologist Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Pulmonologists saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 8% of pulmonologists either participated in an ACO or planned to join one in the coming year. This year saw a huge jump, to 29%.
Also, slightly more pulmonologists have opted for cash-only medical practices in 2012 than in 2011 (2% vs 1%). However, the number of pulmonologists who are in concierge practices remained the same (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 pulmonologists, 8% plan to stop taking new Medicare or Medicaid patients, and 1% plan to stop seeing current Medicare or Medicaid patients. Another 27% are undecided.
That number (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 pulmonologists 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, 29% of pulmonologists 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 25% 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.
Roughly 1 in 6 pulmonologists said yes. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was lower for pulmonologists: 15%. By contrast, 22% of dermatologists, 19% of endocrinologists, and 29% of plastic surgeons 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, nearly 1 in 3 pulmonologists (32%) said that they regularly discuss cost with patients, and another 48% said that they occasionally discuss costs, if a patient brings it up. In 2011, fewer pulmonologists -- 28% -- said that they regularly discussed the cost of care with patients, although a bit more -- 51% -- 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 pulmonologists spends 46-50 hours per week seeing patients. The percentage of doctors who put in that amount of time has remained constant. In both 2012 and 2011, 18% worked 46-50 hours per week. In the previous year, just under 15% 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 more or less similar from one year to the next. In 2012, 15% of pulmonologists worked a 30- to 40-hour week (fewer than in 2011); 13% worked 41-45 hours (about the same as in 2011), 7% worked 51-55 hours (vs 11% in 2011), and 29% worked 56 or more hours (in 2011, it was about 26%).
Number of Patients per Week
The sweet spot for pulmonologists is 50-75 patient visits per week. In 2012, that accounted for 24% of pulmonologists, vs 25% in 2011 and about 15% in 2010. The next-largest group -- 19% in 2012, 16% in 2011, and slightly more than 17% in 2010 -- sees 25-49 patients per week. Patient loads in excess of 100 patients per week are fairly common in pulmonology. Some 28% of pulmonologists saw that many patients in 2012, which is roughly the same amount as in 2011.
Amount of Time Spent With Each Patient
Due to the nature of the specialty, pulmonologists spend a fair amount of time with each patient. For the largest percentage of pulmonologists -- 35% in 2012 -- a mean of 13-16 minutes was the norm per patient visit.
That percentage represents an increase in the number of pulmonologists who saw patients for that long in recent years. In 2011, 24% of pulmonologists saw patients for 13-16 minutes; in 2010, that number was 27%.
About 22% of pulmonologists see patients for less than 13 minutes, a percentage that has risen steadily over the past 3 years. But the number of pulmonologists who see patients for 21 minutes or longer has dropped in the past year: In 2012 it was 24%, in 2011 it was 38%, and in 2010 it was 35%.
Hours Spent Seeing Patients in the Hospital
Pulmonologists, because of their specialty, spend a large portion of their time in the hospital with patients. A full 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 pulmonologists were just as bogged down with such tasks as were many other specialists.
Nearly a fourth of pulmonologists (24%) spent 5-9 hours on paperwork and administration each week, and 30% spent 10-14 hours. Another 21% had 20 hours or more of paperwork per week.
That's pretty close to the load for family physicians: 26% had 5-9 hours of paperwork a week, 28% had 10-14 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 pulmonologists, 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 41%; for physicians overall, that number was lower: 34%.
For 31% of doctors overall, relationships with patients ranked next on the list in 2012. Among pulmonologists, 30% felt the same, although it was still second as a factor in career satisfaction.
Knowing that they're making the world a better place ranked third in importance, with 11% of pulmonologists citing it in 2012 compared with 12% for physicians overall.
When it came to the most rewarding part of their job, pulmonologists were just as likely as doctors overall (7%) to note "being proud of being a doctor" as the chief reward.
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