Tuesday, June 6, 2023
Rheumatologist 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? More than 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
Rheumatologist Compensation in 2012
Physicians have done well in 2012, and rheumatologists have held their own with a mean income of $186,000, tying them with psychiatrists. Topping the list were orthopedists, cardiologists, radiologists, gastroenterologists, and urologists.
Historically, rheumatologists have ranked in the bottom third among the specialties in Medscape's surveys. Still, they saw a small increase in income: In our latest report, they earned more than they did in the previous year.
About 14% of rheumatologists earn $300,000 or more; about 15% 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.
Rheumatologist Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been very little movement in earnings for rheumatologists. In 2012, 49% of respondents said that their compensation remained the same from the previous year, compared with 52% in 2011.
In 2012, 18% of rheumatologists said that they earned more than they earned in 2011, and 33% earned less. However, in 2011 compared with 2010, 27% of rheumatologists said that they earned more and only 22% reported that they made less.
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 rheumatology, however, that gap is 18.2%, less 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, 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%.
Rheumatologist Compensation by Geographical Region
Rheumatologist compensation varies significantly by region. Doctors in the Southeast, with the highest compensation (a mean of $208,000 in 2012), earn much more than their colleagues in the Northwest, with the lowest compensation.
In 2011, there was also a large spread. Rheumatologists earned the most in the North Central region, and earned the least in the Southwest.
Rheumatologist Compensation by Setting
As in Medscape's 2012 Compensation Report, rheumatologists in multispecialty group practices are the top earners, with a mean income of $224,000. This is a little higher than last year's figure of $214,000. Rheumatologists in single-specialty groups, who are also among the highest earners, saw an income decline: $206,000 in 2012 vs $228,000 in 2011.
Independent contractors earned more than employed physicians and those in solo practice, although partners beat them all. Rheumatologists working in hospitals earned a mean of $201,000 in 2012, a whopping increase from $139,000 in 2011. Those working in healthcare organizations also did much better in 2012 than in 2011. Rheumatologists in academic settings were at the bottom of the pack in 2012 with $137,000, but they saw an increase from 2011 ($120,000).
Do Rheumatologists Feel Fairly Compensated?
Fewer rheumatologists feel fairly compensated than not (43% vs 57%), which represents an erosion in feelings about earnings fairness. In 2010, 53% of rheumatologists felt fairly compensated. In 2011, that number was 42%, more in line with this year's figure.
Compared with all physicians, rheumatologists 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 rheumatologists less so than other doctors, the number of rheumatologists who would choose medicine again as a career has declined nevertheless. Less than half (49%) would do so in 2012 vs 56% in 2011.
However, among rheumatologists who said that they would opt in again, 49% would choose the same specialty in 2012, more than 2011's 42%.
Nevertheless, there were ripples of discontent about practice setting. In 2012, only 25% of rheumatologists said that they would choose the same practice setting, compared with 21% in 2011.
Rheumatologist Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Rheumatologists saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 8% of rheumatologists either participated in an ACO or planned to join one in the coming year. This year saw a huge jump, to 23%.
Also, more rheumatologists have opted for concierge medical practices in 2012 than in 2011 (3% vs 1%). The same is true of rheumatologists who are in cash-only practices (2% 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 rheumatologists, 10% plan to stop taking new Medicare or Medicaid patients, and 3% plan to stop seeing current Medicare or Medicaid patients. Another 34% 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, 53% of rheumatologists 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 3 rheumatologists (36%) 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 15% 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.
Many rheumatologists said yes. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was about the same for rheumatologists: 17%. 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 2011, more than half of rheumatologists (56%) said that they regularly discuss cost with patients, and another 33% said that they occasionally discuss costs, if a patient brings it up. In 2012, even more rheumatologists -- 58% -- said that they regularly discussed the cost of care with patients, although fewer -- 26% -- 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 rheumatologists 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 and 2011, about 38% of rheumatologists worked 30-40 hours per week. In the previous year, 40% worked those hours. Similarly, 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, 15% of rheumatologists worked a 41- to 45-hour week (up from 11% in 2011); 9% worked 46-50 hours (about the same as in 2011), 6% worked 51-55 hours (also about the same), and 7% worked 56 or more hours (in 2011, it was about 5%).
Number of Patients per Week
The sweet spot for rheumatologists is 50-75 patient visits per week. In 2012, that accounted for 26% of rheumatologists, the same amount as in 2011 and 2010. The next largest group -- 21% in 2012, 23% in 2011, and slightly more than 25% in 2010 -- sees 76-99 patients per week. Patient loads in excess of 100 patients per week are fairly common in rheumatology. About 23% of rheumatologists saw that many patients in 2012, roughly equivalent to the number in 2011.
Amount of Time Spent With Each Patient
Due to the nature of the specialty, rheumatologists spend more time with each patient than do many other types of doctors. For the largest percentage of rheumatologists -- 33% in 2012 -- a mean of 13-16 minutes was the norm per patient visit.
That percentage represents an increase in recent years in the number of rheumatologists who saw patients for that long. In 2010 and 2011, 25% of rheumatologists saw patients for 13-16 minutes.
Only 8% of rheumatologists see patients for less than 13 minutes, a percentage that has remained stable from last year. But the number of rheumatologists who see patients for 21 minutes or longer has dropped sharply in the past year: In 2012 it was 26%; in 2011 it was 40%.
Hours Spent Seeing Patients in the Hospital
Rheumatologists, because of their specialty, spend very little of their time in the hospital with patients. A full 37% spends less than an hour per week seeing patients in the hospital. Another 45% spends a mere 1-4 hours.
By comparison, 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 rheumatologists were as bogged down with such tasks as were many other specialists.
Almost a third of rheumatologists (31%) spent 10-14 hours on paperwork and administration each week, and another 14% spent 15-19 hours. About 22% had 20 hours or more of paperwork per week. Just 12% got away with putting in 1-4 hours.
Like rheumatologists, 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 rheumatologists, 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 49%; for physicians overall, that number was 34%.
For 31% of doctors overall, relationships with patients ranked next on the list in 2012. Among rheumatologists, 26% 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 10% of rheumatologists citing it in 2012 compared with 12% for physicians overall.
When it came to the most rewarding part of their job, however, rheumatologists (5%) were less likely than doctors overall (7%) to note "being proud of being a doctor" as the chief reward.
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Medscape's Best Places to Practice
Medscape Physician Compensation Report: 2012 Results
Medscape Physician Lifestyle Report: 2012 Results
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