Pediatricians 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, pediatricians ranked lowest ($189,000). The other lowest earners, starting from second-to-last place, are 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 2014 compensation is compared with the prior year's, pediatricians 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%).

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 $7000, pediatricians are second from last 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 pediatricians are earning more than their female counterparts. The percentage difference between self-employed (14%) and employed (13%) male and female pediatricians is nearly the same. Women tend to work shorter hours and fewer weeks than men, which may help account for the lower compensation reported among female pediatricians.^[1] (Note: This chart includes full-time workers only but does not control for hours worked.)

Only 43% of female pediatricians are satisfied with their income, which is far lower than the rate reported by their male counterparts (57%). Female pediatrician satisfaction is also much lower than what they reported last year (51%), whereas male satisfaction (57%) did not change.

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 pediatricians were reported in the South Central ($206,000) and North Central ($198,000) regions, whereas the lowest were in the Mid-Atlantic and Southwest regions (both at $182,000) and the Southeast ($184,000). The 2011 Medscape Pediatrician Compensation Report indicates some change in these regional differences; the highest pediatrician earners were in the North Central region ($158,500), and the lowest were in the Northeast ($135,000).

Employed pediatricians make $180,000, which is less than their self-employed counterparts ($213,000). A number of factors in 2015 might negatively affect compensation for employed or self-employed pediatricians, including the end of ACO shared-savings programs, meaningful use penalties, payment-reporting websites, and changes in CPT codes.^[3]

Given that employed pediatricians make less than those who are self-employed, it is of some interest that over one half (52%) of employed pediatricians believe that they are fairly compensated, compared with less than one half (47%) of those who are self-employed. This is a reversal from the 2011 Medscape report, when fewer employed pediatricians reported satisfaction (about 48%), and significantly more self-employed pediatricians (about 53%) believed that they were fairly compensated.

Pediatricians in office-based single-specialty group practices make the most ($203,000), followed by healthcare organizations ($199,000). Those who earn the least money are in academic or government centers ($162,000) and outpatient settings ($171,000). In 2014, pediatricians in office-based single-specialty group practices earned the most ($193,000), but pediatricians in outpatient clinics earned the least ($154,000).

In the 2011 Medscape report, 74% of pediatricians said they would choose medicine again and 62% would select their own specialty. This year, a decreased 67% would still choose medicine, and only 51% would select their own specialty. Furthermore, in 2011, 52% said they would choose their own practice setting, but this year a mere 18% would go that same route.

To determine the level of general career satisfaction, Medscape averaged the percentage of pediatricians who again would choose medicine, those who would choose their own specialty, and those who thought they were fairly compensated. Despite their low compensation levels, at 56%, pediatricians tied with emergency physicians, coming in fourth in overall satisfaction—the same percentage as last year, but slightly lower in ranking (third last year). According to the calculation, the most satisfied physicians this year are dermatologists (63%), followed by psychiatrists and pathologists (both at 57%). The least satisfied, from the bottom up, are internists (47%), nephrologists (48%), and general surgeons (49%).

Despite considerable publicity, cash-only and concierge practices are still not significant payment models for pediatricians.^[4] This has changed little since last year. Participation in accountable care organizations, however, continues to rise steadily, from 28% last year to 31% currently, with 7% 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 64% of self-employed pediatricians 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 61% of self-employed pediatricians said they would take these patients. Little change was observed in those not taking Medicaid or Medicare. There was a decline among undecided employed pediatricians between last year and now, from 16% to 8%. This decline, coupled with the increase in those taking Medicaid/Medicare patients, suggests that more undecided pediatricians opted to take these patients. Among those who were self-employed, the percentage of undecided pediatrician's remained the same (16%).

In a Medscape report on insurers conducted in 2014, well over one 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, 18% of pediatricians said they would and 40% would not. (The question was not applicable to the remaining survey respondents.)

According to Medscape survey findings, 17% of employed and 22% of self-employed pediatricians say they have offered new ancillary services within the past 3 years. Ancillary services in pediatrics practices can include hearing and vision screening, pulmonary services, imaging, nutrition, and basic laboratory services.

Seventy-six percent of pediatricians say they discuss the cost of treatment with patients, although only 18% do this regularly. Seven 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]

Sixty percent of pediatricians spend 30-45 hours per week seeing patients. One quarter 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 physicians 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 among self-employed pediatricians and those who are employed: 54% of those who work for themselves spend 10 or more hours per week on these tasks, compared with 58% of those who work for others.

Seventy-one percent of pediatricians spend 16 minutes or less per patient. Twenty-eight percent spend more time than that.

Nearly one third (32%) of female pediatricians and 15% of male pediatricians work part-time—somewhat higher percentages than those in the general physician population, where 24% of female and 13% of male physicians work part-time.

The largest group (31%) of part-time pediatricians are the oldest age group (those 65 and older). Nearly 50% of pediatricians in middle age (35-64) work part time. Ten percent of those under 35 work part-time.

Female and male pediatricians reported only very slight differences in what they found most rewarding about their jobs. Forty-three percent of women and 42% of men believed that relationships with patients are a major source of satisfaction. About one quarter of both men (24%) and women (25%) cited being very good at their job as a reward, and more male (8%) than female (6%) pediatricians named making good money. Being proud of being a doctor was last on the list as a reward for both genders. A discouraged 5% of women and 3% of men found nothing rewarding in being a pediatrician.

Only 21% of pediatricians are planning on participating in health insurance exchanges, which is down from 31% last year. This year, nearly one quarter (23%) of pediatricians said they were not participating, up from 14% in the 2014 Medscape report.

The responses of pediatricians are similar to PCPs in adult care when considering the impact of health insurance exchanges on their income. Eight percent of pediatricians believe that their income is likely to increase with health insurance exchanges, whereas 10% of PCPs think it will rise. The same percentage of pediatricians as PCPs believe that their income will decrease (27%).