General surgeons who responded to this year's Medscape compensation survey described their compensation, number of hours worked, practice changes resulting from healthcare reform, and how they have adapted to the new healthcare environment.

When asked about their compensation for patient care, general surgeons came in above the middle ($317,000). The lowest earners, starting from last place, are pediatricians ($189,000), family physicians ($195,000), and endocrinologists and internists (both at $196,000). The top earners this year are orthopedists ($421,000), cardiologists ($376,000), and gastroenterologists ($370,000). The top earners have changed from the 2011 Medscape Compensation Report. Although orthopedists led that year as well, the next top earners were radiologists and anesthesiologists. The bottom earners then were still pediatricians, PCPs, and endocrinologists. Note: Values in the charts have been rounded. Caption sums may not agree with chart value sums due to rounding.

When comparing 2014 compensation with the prior year's, general surgeons reported an increase of 7%. Only rheumatologists experienced any large decrease in income (4%). Urologists were the only other specialists to see a decline, but by only 1%. The rest of the physicians reported an increase. The greatest increases appeared among infectious disease physicians (22%), followed by physicians who mostly work in hospitals: pulmonologists (15%) and emergency medicine physicians and pathologists (both at 12%).

Orthopedists, who make the most from patient-care work, are also at the top of the list for compensation from non–patient care activities ($29,000). Non–patient care activities include expert witness duties, product sales, and speaking engagements. At $14,000, general surgeons are slightly below the middle among specialists in non–patient care compensation. Physicians (and notably PCPs) who are at the lower end of patient-work compensation also tend to trail in non–patient care compensation.

This year, as in all previous years of the report, male general surgeons are earning more than their female counterparts, by 28% among both self-employed and employed groups. Women tend to work shorter hours and fewer weeks than men, which may help account for the lower female compensation reported among general surgeons.^[1] (Note: This chart includes full-time workers only but does not control for hours worked.)

On interest, although female general surgeons make less than their male counterparts, both groups have low (and similar) satisfaction rates regarding their compensation (41% and 42%, respectively). Furthermore, gender satisfaction rates last year were the same in both groups (43%) and only slightly higher than this year.

In setting Medicare fees, the challenge for CMS is to address the higher cost of living in certain areas against the need to attract physicians to underserved places with lower cost of living.^[2] Additionally, competition and physician density play a role in physician salaries. This year, the highest earnings for general surgeons were reported in the North Central ($328,000) and Great Lakes ($327,000) regions, while the lowest were in the West ($292,000) and South Central ($303,000). The 2011 Medscape General Surgeon Compensation Report indicates a slight change in these regional differences; the highest general surgeon earners were still in the North Central ($342,000) but the lowest were in the Northwest ($275,000).

Employed general surgeons make $306,000, which is less than their self-employed counterparts ($339,000). A number of factors in 2015 might negatively affect compensation for employed or self-employed general surgeons, including the end of ACO shared savings programs, meaningful use penalties, payment-reporting websites, and changes in CPT codes.^[3]

Given that employed general surgeons make less than those who are self-employed, it is of some interest that over half (52%) of employed general surgeons believe that they are fairly compensated, compared with less than a quarter (23%) of those who are self-employed. In the 2011 Medscape report, employed general surgeons reported no change in satisfaction, although more self-employed (38%) general surgeons believed that they were fairly compensated at that time.

General surgeons in healthcare organizations make the most ($390,000), followed by office-based multispecialty groups ($386,000). Those who earn the least money are in academic or government centers ($218,000) and office-based solo practices ($283,000). When comparing these practice settings with those in 2014, general surgeons who earned the most last year were also in healthcare organizations ($347,000), but in 2014, general surgeons in outpatient clinics earned the least ($145,000).

In the 2011 Medscape report, 69% of general surgeons said they would choose medicine again and 60% would select their own specialty. This year, only 55% would still choose medicine, and only half would select their own specialty. Furthermore, in 2011, 49% said they would choose their own practice setting, but this year only 22% would go that same route.

To determine the level of general career satisfaction, Medscape averaged the percentage of general surgeons who again would choose medicine, those who would choose their own specialty, and those who thought they were fairly compensated. At 49%, general surgeons came in third from the bottom in overall satisfaction, which is only slightly higher than last year's percentage (48%) when they were fifth from the bottom. The other least satisfied, from the bottom up, are internists (47%) and nephrologists (48%). According to the calculation, the most satisfied physicians this year are dermatologists (63%), followed by pathologists and psychiatrists (both at 57%).

Despite considerable publicity, cash-only and concierge practices are still not significant payment models for general surgeons.^[4] This has changed little since last year. Participation in accountable care organizations, however, continues to rise, from 26% last year to 32% currently, with 9% more expecting to be part of an ACO this year.

The American Medical Association has warned that the "'regulatory tsunami' facing US physicians could cut Medicare payments by more than 13% by the end of the decade."^[5] Nevertheless, 87% of employed and 67% of self-employed general surgeons said they will continue taking new and current Medicare or Medicaid patients, which is up from their responses last year, when 80% of employed and 58% of self-employed general surgeons said they would take these patients. Little change was observed in those not taking Medicaid or Medicare. There was a decline among undecided employed general surgeons between last year and now, from 16% to 11%, and among those who were self-employed, from 28% to 19%. This decline, coupled with the increase in those taking Medicaid/Medicare patients, suggests that more undecided doctors opted to take these patients.

In a Medscape report on insurers conducted in 2014, well over half (58%) of all physicians received less than $100 from private insurers for a new-patient office visit. In the current report, when asked whether they would drop insurers who pay poorly, 24% of general surgeons said they would and 46% would not. (The question was not applicable to the remaining survey respondents.)

According to Medscape survey findings, 17% of employed and 18% of self-employed general surgeons say they have offered new ancillary services within the past 3 years. Ancillary services in general surgery practices can include ambulatory surgery centers, physical therapy, radiology, and MRI.

Over three quarters (76%) of general surgeons say they discuss the cost of treatment with patients, although only 14% do this regularly. Eleven percent are unaware of the cost of treatment. A 2013 editorial in the New England Journal of Medicine stressed the benefits of such discussions, including finding lower-cost alternatives and making trade-offs, and noted that it is "well within physicians' traditional duties to discuss such matters with our patients."^[6]

Forty-two percent of general surgeons spend 30-45 hours per week seeing patients. Fewer than half (47%) spend more than that. A JAMA study of all physicians found that between 1997 and 2007, there was a decrease among all physicians of nearly 4 hours per week in seeing patients, which may be partly related to the declining fees over that same period.^[7] Another reason for the decline is the increasing proportion of women and older physicians, who tend to work shorter hours and fewer weeks.^[1]

In a 2012 survey, physicians reported spending 22% of their time on nonclinical paperwork.^[8] Paperwork load is nearly equal between employed and self-employed general surgeons: 68% of both groups spend 10 or more hours per week on this. Of interest, the same percentage of self-employed PCPs (68%) spend this amount of time on paperwork. At 61%, employed PCPs spend slightly less time on paperwork than do employed general surgeons.

Over half (52%) of general surgeons spend 16 minutes or less per patient. Forty-eight percent spend more than that.

Only 13% of female general surgeons and 10% of male general surgeons work part-time, far lower percentages than those in the general physician population, where nearly a quarter (24%) of female and 13% of male physicians work part-time.

The oldest general surgeons (65 and older) make up the largest part-time group, but only 19% of them are not full-time. One percent of those under 35 and very few (3%-7%) of those in middle age work part-time.

Female and male general surgeons reported only slight differences in what they found most rewarding about their jobs. Forty-one percent of women and 36% of men believe that relationships with patients are a major source of satisfaction. About a third of both men and women (34%) cited being very good at their job as a reward. Three percent of men and 1% of women found nothing rewarding.

Less than a quarter (24%) of general surgeons are planning on participating in health insurance exchanges, which is down from 30% last year. This year, 22% of general surgeons said they were not participating, up from 16% in the 2014 Medscape report.

General surgeons are more pessimistic than PCPs when considering the impact of health insurance exchanges on their income. Only 6% of general surgeons believe that their income is likely to increase with health insurance exchanges, while 10% of PCPs think it will rise. Forty-two percent of general surgeons believe that their income will decrease, compared with 27% of PCPs.