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References

  1. US Department of Health and Human Services. The Physician Workforce. December 2008. http://bhpr.hrsa.gov/healthworkforce/reports/physwfissues.pdf Accessed March 7, 2015.
  2. Geographic Adjustment in Medicare: Phase I: Improving Accuracy, Second Edition. Committee on Geographic Adjustment Factors in Medicare Payment; Board on Health Care Services; Institute of Medicine; Edmunds M, Sloan FA, editors. Washington, DC: National Academies Press; 2011 Jun 1. http://www.ncbi.nlm.nih.gov/books/NBK190061/ Accessed March 7, 2015.
  3. Page L. 12 changes that will affect doctors' income in 2015. Medscape Business of Medicine. November 25, 2014. http://www.medscape.com/viewarticle/835123 Accessed March 7, 2015.
  4. Bellafante G. Enhanced medical care for an annual fee. New York Times. December 6, 2013. http://www.nytimes.com/2013/12/08/nyregion/enhanced-medical-care-for-an-annual-fee.html?_r=0 Accessed February 14, 2015.
  5. CMTDPCJOURNAL. AAFP creates policy on direct primary care. http://conciergemedicinenews.wordpress.com/2013/05/17/aafp-creates-policy-on-direct-primary-care/ Concierge Medicine Today. May 17, 2013. Accessed February 14, 2015.
  6. AAFP News. What's all the buzz about direct primary care? May 6, 2014. http://www.aafp.org/news/practice-professional-issues/20140506forrestdpctalk.html Accessed March 7, 2015.
  7. Brooks M. Less money, more rules for US physicians in 2015. Medscape Medical News. January 2, 2015. http://www.medscape.com/viewarticle/837493 Accessed January 14, 2015.
  8. Ubel PA, Abernethy AP, Zafar SY. Full disclosure--out-of-pocket costs as side effects. N Engl J Med. 2013;369:1484-1486. http://www.nejm.org/doi/full/10.1056/NEJMp1306826 Accessed March 5, 2015.
  9. Staiger DO, Auerbach DI, Buerhaus PI. Trends in the work hours of physicians in the United States. JAMA. 2010;303:747-753. http://jama.jamanetwork.com/article.aspx?articleid=185433 Accessed February 24, 2015.
  10. A Survey of America's Physicians. Practice Patterns and Perspectives. The Physicians Foundation. September 2012. http://www.physiciansfoundation.org/uploads/default/Physicians_Foundation_2012_Biennial_Survey.pdf Accessed March 7, 2015.
  11. Sibert KS. Don't quit this day job. New York Times. June 11, 2011. http://www.nytimes.com/2011/06/12/opinion/12sibert.html?src=me&ref=general Accessed March 7, 2015.
  12. Pollart SM, Dandar V, Brubaker L, et al. Characteristics, satisfaction, and engagement of part-time faculty at U.S. medical schools. Acad Med. 2015;90:355-364. https://www.aamc.org/download/405992/data/characteristicssatisfactionandengagementofpart-timefacultyinu.s.pdf Accessed March 7, 2015.
  13. Clem KJ, Promes SB, Glickman SW, et al. Factors enhancing career satisfaction among female emergency physicians. Ann Emerg Med. 2008;51:723-728.
  14. McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K. The work lives of women physicians results from the physician work life study. The SGIM Career Satisfaction Study Group. J Gen Intern Med. 2000;15:372-380. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495474/ Accessed March 9, 2015.
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Carol Peckham
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Art Science Code LLC
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Disclosure: Carol Peckham has disclosed no relevant financial relationships.

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Medscape Internist Compensation Report 2015

Carol Peckham  |  April 21, 2015

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Slide 1

Internists 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.

Slide 2

When asked about their compensation for patient care, internists tied with endocrinologists for third from the bottom ($196,000). The other lowest earners are pediatricians ($189,000) and family physicians ($195,000). 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. Note: Values in the charts have been rounded. Caption sums may not agree with chart value sums due to rounding.

Slide 3

When comparing 2014 compensation with the prior year's, internists reported an increase of 4%. 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%).

Slide 4

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 $11,000, internists are toward the bottom 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.

Slide 5

This year, as in all previous years of the report, male internists are earning more than their female counterparts. There are no differences in the percentage of gender disparity (11%) whether internists are employed or self-employed. Women tend to work shorter hours and fewer weeks than men, which may help account for the lower female compensation reported among internists.[1] (Note: This chart includes full-time workers only but does not control for hours worked.)

Slide 6

Although fewer than half of primary care physicians—internists at 45% and family physicians at 48%—believe that they are fairly compensated, they are not the most dissatisfied physicians. Those who feel most underpaid are ophthalmologists (40%) and allergists and general surgeons (both 41%). Those most likely to believe that they are paid fairly are dermatologists (61%) and emergency medicine physicians and pathologists (both 60%). Of interest, the two latter groups reported a 12% rise in compensation this year, which was among the top four increases.

Slide 7

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 internists were reported in the South Central ($215,000) and West ($213,000) regions, while the lowest were in the Northeast ($181,000) and the Mid-Atlantic ($186,000). The 2011 Medscape Internist Compensation Report indicates a change in these regional differences; the highest internist earners were in the West ($188,000) and the South Central and Southeast (both $180,000) regions, and the lowest were in the Northeast ($150,000) and Mid-Atlantic ($153,000).

Slide 8

Employed internists make $191,000, which is less than their self-employed counterparts ($208,000). A number of factors in 2015 might negatively affect compensation for employed or self-employed internists, including the end of ACO shared savings programs, meaningful use penalties, payment-reporting websites, and changes in CPT codes.[3]

Slide 9

Given that employed internists make less than those who are self-employed, it is of some interest that about half (49%) of employed internists believe that they are fairly compensated, compared with 33% of those who are self-employed. In the 2011 Medscape report, employed physicians reported little change in satisfaction, although more self-employed internists (slightly over 40%) believed that they were fairly compensated at that time.

Slide 10

Internists in office-based multispecialty group practices make the most ($219,000), followed by those in single-specialty groups ($209,000). Those who earn the least money are in academic or government centers ($164,000) followed by those in solo practices ($182,000). When comparing these practice settings with those in 2014, internists who earned the most last year were in healthcare organizations ($203,000), followed by multispecialty groups ($200,000). Internists in academic and government centers still earned the least ($161,000), followed by those in outpatient clinics ($167,000).

Slide 11

In the 2011 Medscape report, 70% of internists said they would choose medicine again and 41% would select their own specialty. This year, 71% would still choose medicine, but far fewer—25%—would select their own specialty. Furthermore, in 2011, 44% said they would choose their own practice setting, but this year only 23% would go that same route.

Slide 12

To determine the level of general career satisfaction, Medscape averaged the percentage of internists who again would choose medicine, those who would choose their own specialty, and those who thought they were fairly compensated. At 47%, internists were the least satisfied of all physicians, which is the same percentage as they reported last year (although third from the bottom then). This year, the next least satisfied, from the bottom up are nephrologists and general surgeons (48% and 49%, respectively). According to the calculation, the most satisfied physicians this year are dermatologists (63%), followed by pathologists and psychiatrists (both at 57%).

Slide 13

Despite considerable publicity, cash-only and concierge practices are still not significant payment models for internists.[4] This has changed little since last year. In fact, cash-only practices declined from 5% to 4%, although interest in direct primary care is still growing among primary care leaders.[5,6] (Direct primary care is not the same as concierge primary care, but it also employs an alternative to fee-for-service insurance billing by charging a retainer for a full range of services.) Participation in accountable care organizations, however, continues to rise dramatically, from 29% last year to 34% currently, with 7% more expecting to be part of an ACO this year.

Slide 14

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."[7] Nevertheless, 76% of employed and 59% of self-employed internists said they will continue taking new and current Medicare or Medicaid patients, and these percentages are both up from their responses last year, when 67% of employed and 53% of self-employed internists said they would take these patients. Little change was observed in those not taking Medicaid or Medicare. There was a strong decline among undecided employed internists between last year and now, from 30% to 18%, and among those self-employed, from 25% to 20%. This decline, coupled with the increase in those taking Medicaid/Medicare patients, suggests that more undecided doctors opted to take these patients.

Slide 15

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, 20% of internists said they would and 32% would not. (The question was not applicable to the remaining survey respondents.)

Slide 16

According to Medscape survey findings, 19% of employed and 26% of self-employed internists say they have offered new ancillary services within the past 3 years. In last year's report, 20% of all internists reported adding these services, which can include medication dispensing, weight-loss services, in-office diagnostic tests, nutrition counseling, cosmetic services, and alternative treatments such as acupuncture and massage.

Slide 17

Seventy-six percent of internists say they discuss the cost of treatment with patients, and 27% do this regularly. 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."[8]

Slide 18

Half of internists spend 30-45 hours per week seeing patients, and 39% 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.[9] Another reason for the decline is the increasing proportion of women and older physicians, who tend to work shorter hours and fewer weeks.[1]

Slide 19

In a 2012 survey, physicians reported spending 22% of their time on nonclinical paperwork.[10] This year, paperwork load is slightly heavier among self-employed internists compared with those who are employed: 67% of those who work for themselves spend 10 or more hours per week on these tasks compared with 60% of those who work for others. Of interest, more self-employed PCPs spend this amount of time on paperwork than many other self-employed specialists do, which might be attributed to their wider range of cases, requiring more complex billing and coding. In a Medscape 2014 survey on employed physicians, not having to deal with the business of running a practice and not having to deal with insurers and billing were the top two reasons why physicians sought employment (58% and 45%, respectively, cited these two reasons).

Slide 20

Less than half (46%) of internists spend 16 minutes or less per patient. Fifty-five percent spend more than that.

Slide 21

In 2010, 48% of medical degrees in all specialties were earned by women. Given the growing physician shortage, it may be of some concern that just under a quarter (22%) of female internists who responded to the survey work part-time compared with only 10% of men. Furthermore, data also suggest that even women who are full-time work fewer hours each week and see fewer patients than their male colleagues.[1,11] Studies indicate that greater schedule flexibility and fewer hours are key factors in improving female physician satisfaction and preventing burnout.[12-14]

Slide 22

The largest group of part-time internists are the oldest members (65 and older), but only 23% of them are not full-time. Fourteen percent of those in middle age work part-time.

Slide 23

Female and male internists reported slight differences in what they found most rewarding about their jobs. Forty percent of women compared with only about a third (34%) of men believed that relationships with patients are a major source of satisfaction. About the same percentage of men (29%) and women (28%) cited being very good at their job as a reward. Being proud of being a doctor was a reward for only 10% of men and 9% of women. Two percent of male and 3% of female internists found nothing rewarding.

Slide 24

Twenty-one percent of internists are planning on participating in health insurance exchanges, which is down from 26% last year, although still higher than the response by specialists (19%). This year, 25% of internists said they were not participating, up from 18% in the 2014 Medscape report.

Slide 25

Internists were asked what impact health insurance exchanges would have on their income. Many physicians may have already felt their effect. Internists are less pessimistic than specialists in general when considering the impact of health insurance exchanges on their income. Seventy-six percent of internists believe that their incomes are likely to stay the same or even increase with health insurance exchanges, compared with 61% of specialists. In addition, 25% of internists believe that their income will decrease, compared with 39% of specialists.

Slide 26
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