Monday, September 25, 2023
Urologist 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
Urologist Compensation in 2012
Physicians have done well in 2012, and urologists are near the top of the ranks. Urologists were the fifth highest ranked specialty, with a mean income of $340,000. Topping the list were orthopedists, cardiologists, radiologists, and gastroenterologists.
Historically, urologists have ranked high among the specialties in Medscape's surveys. In our 2012 report, urologists ranked fourth highest (in a dead heat with anesthesiologists), while in the previous year they were fifth.
About 16% of urologists earn $500,000 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.
Urologist Compensation in 2012 vs 2011
Compared with Medscape's 2012 Compensation Report, there has been some slight movement in earnings for urologists. In 2012, 42% of respondents said that their compensation remained the same from the previous year, compared with 35% in 2011.
In 2012, 23% of urologists said that they earned more than in 2011, and 36% earned less -- very similar to the earnings situation in 2011 compared with 2010.
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 urology, however, that difference is about 14%, 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, 8% of urologist 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%.
Urologist Compensation by Geographical Region
Urologist compensation varies significantly by region. Doctors in the Great Lakes region earn more than their colleagues in the Mid-Atlantic region.
In 2011, the spread was not as wide. Urologists earned the most (a mean of $343,000) in the West, $71,000 more than urologists earning the least (a mean of $272,000 in the Mid-Atlantic region).
Urologist Compensation by Setting
As in Medscape's 2012 Compensation Report, urologists in multispecialty group practices are the top earners, with a mean income of $412,000. This is a little higher than last year's figure of $397,000. Urologists in single-specialty groups, who are also among the highest earners, saw a slightly bigger increase: $377,000 in 2012 vs $355,000 in 2011.
Employed physicians earned more than those in solo practice, although partners beat them all. Urologists working in hospitals earned a mean of $328,000 in 2012. Those working in healthcare organizations also enjoyed a big increase in 2012 vs 2011. Urologists in academic settings were at the bottom of the pack in 2012 with $252,000, but they, too, saw a large increase from 2011.
Do Urologists Feel Fairly Compensated?
Fewer urologists feel fairly compensated than not (48% vs 52%), and this represents an erosion in feelings about earnings fairness. In 2010, about 52% of urologists felt fairly compensated. In 2011, that number had dropped to just 40% -- despite the fact that urology is one of the highest-paid medical specialties.
Compared with all physicians, however, urologists feel no more or no less 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...
Although the changing healthcare environment appears to have affected urologists less so than other doctors, the number of urologists who would choose medicine again as a career has declined. Only 43% would do so in 2012 vs 46% in 2011.
However, among urologists who said that they would opt in again, 60% would choose the same specialty in 2012, higher than 2011's 51%.
On the other hand, there were ripples of discontent about practice setting. In 2012, only 21% of urologists said that they would choose the same practice setting, compared with 24% in 2011.
Urologist Participation in Various Payment Models
Clearly there are changes in the way doctors are earning money.
Healthcare reform is having an impact. Urologists saw a big uptick in participation in Accountable Care Organizations (ACOs). In last year's Compensation Report, only 7% of urologists either participated in an ACO or planned to join one in the coming year. This year saw a huge jump, to 20%.
Also, slightly more urologists have opted for concierge medical practices in 2012 than in 2011 (2% vs <1%). The same is true of urologists 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 urologists, 8% plan to stop taking new Medicare or Medicaid patients, and 2% plan to stop seeing current Medicare or Medicaid patients. Another 35% 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, 55% of urologists 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, 2 in 5 urologists (40%) were planning to take this advice, or perhaps they do it already. But 21% 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 urologists said yes. Across all specialties, only 19% of doctors said that they had begun to do so. That percentage was higher for urologists: 21%. By contrast, 19% of endocrinologists, 22% of dermatologists, 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, 36% of urologists said that they regularly discuss cost with patients, and another 53% said that they occasionally discuss costs, if a patient brings it up. In 2012, fewer urologists -- 26% -- said that they regularly discussed the cost of care with patients, and fewer -- 50% -- 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 urologists spends 30-40 hours per week seeing patients. The percentage of doctors who put in that amount of time has remained fairly constant. In 2012, 21% worked 30-40 hours per week. In 2011, it was 24% and in the previous year, 17%. 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, 17% of urologists worked a 41- to 45-hour week; 15% worked 46-50 hours, 8% worked 51-55 hours, and 23% worked 56 or more hours. These percentages are more or less the same as those reported for 2011.
Number of Patients per Week
The sweet spot for urologists is 50-75 patient visits per week. In 2012, that accounted for 25% of urologists, vs 20% in 2011 and nearly 23% in 2010. The next-largest group -- 20% in 2012, 26% in 2011, and 25% in 2010 -- sees 76-99 patients per week. Patient loads in excess of 100 patients per week are common in urology. About a third of urologists saw that many patients in 2012, roughly the same as in 2011.
Amount of Time Spent With Each Patient
Due to the nature of the specialty, urologists spend a fair amount of time with each patient. For the largest percentage of urologists -- 36% in 2012 -- a mean of 13-16 minutes was the norm per patient visit.
That percentage represents a slight decline in recent years in the number of urologists who saw patients for that long. In 2011, 37% of urologists saw patients for 13-16 minutes; in 2010, that number was 39%.
About 41% of urologists see patients for less than 13 minutes, a percentage that has remained stable over the past 3 years. But the number of urologists who see patients for more than 20 minutes has dropped slightly in the past year: In 2012, it was 6%; in 2011, it was 8%.
Hours Spent Seeing Patients in the Hospital
Urologists spend very little of their time in the hospital with patients. Almost three fourths (72%) spend 9 hours or less per week seeing patients in the hospital. Just 4% spend 25 or more hours a week.
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. And urologists were just as bogged down with such tasks as were many other specialists.
Only 1 in 7 urologists (15%) spent just 1-4 hours on paperwork and administration each week; another 30% spent 5-9 hours, and 31% logged 10-14 hours. Some 13% had 20 hours or more of paperwork per week.
Like urologists, 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 urologists, there are clearly plenty of emotional rewards that still have a strong impact. Being good at the practice of medicine was the key reward for 32%; for physicians overall, that number was nearly identical: 34%.
For 31% of doctors overall, relationships with patients ranked next on the list in 2012. Among urologists, 37% felt the same, making it the number-one factor in career satisfaction.
Good compensation tied for third in importance (with "making the world a better place"), with 9% of urologists citing it in 2012 -- the same percentage as for physicians overall.
When it came to the most rewarding part of their job, however, urologists (6%) were a touch less likely than doctors overall (7%) to note "being proud of being a doctor" as the chief reward.
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