Anesthesiologists who responded to this year's Medscape compensation survey disclosed not only their compensation but also how many hours they work per week, how many minutes they spend with each patient, the most rewarding part of their job, changes to their practice resulting from healthcare reform, and more. (Note: Values in charts have been rounded and may not match the sums described in the captions.)

Physicians were asked to provide their annual compensation for patient care. For employed physicians, patient-care compensation includes salary, bonus, and profit-sharing contributions. For partners, this includes earnings after taxes and deductible business expenses but before income tax. When asked about their compensation for patient care, anesthesiologists were seventh from the top ($360,000), slightly lower than in last year's compensation report ($358,000), when they were fourth from the top. Orthopedists and cardiologists were numbers one and two this year ($443,000 and $410,000, respectively) and last year as well, at $421,000 and $376,000. Within these specialties there is likely to be a wide range of earnings, as orthopedics and cardiology both include surgical subspecialists, who tend to make significantly more than their generalist counterparts.^[1]

Anesthesiologists had a 1% increase in income this year, near the smallest among all physicians. Internists experienced an unexpected 12% increase. When asked about this greater than normal increase, Travis Singleton, senior vice president of national physician search firm Merritt Hawkins, commented that the migration to hospital medicine has shrunk the candidate pool, while at the same time, "over 10,000 baby boomers turn 65 every day, driving demand for internists—and their compensation—higher." Only two specialties, allergy/immunology and pulmonology, experienced a notable decrease in income (-11% and -5%, respectively). Pathologists and plastic surgeons remained stable. The rest of the physicians reported an increase. When asked what they attributed their increases to, several anesthesiologists responded that they were working more hours. A few had experienced an increase in patient volume. Others simply received expected raises or had changed jobs or positions.

This year, the highest earnings for anesthesiologists were reported in the North Central region ($413,000), the Southwest ($385,000), and the Southeast ($369,000). The lowest were in the Mid-Atlantic ($342,000) and Northwest ($344,000). Geographic supply and demand continues to play a role in compensation; uneven concentrations of physicians relative to patient population, particularly in primary care, has been a problem for decades in rural and poor communities.^[2] Numerous government policies are aimed at improving access to physicians in these areas, including a program that pays bonuses for working in underserved areas and health professional shortage areas (HPSAs). As a result, surveys indicate that higher incomes are found in these regions.^[3] Nevertheless, according to Travis Singleton of Merritt Hawkins, "While government programs certainly influence compensation, it is largely socioeconomics and competition that drive compensation on a macro scale. We are seeing the compensation gap between rural and urban areas diminish. Where it was once routine to see salaries 10%-15% higher 2-3 hours outside of the metropolitan market, now you see urban markets with large delivery systems raise salaries to level the playing field. In turn, that has caused smaller, more rural markets to add more compensation via salary, signing bonuses, and loan forgiveness."

Anesthesiologists who make the most are in healthcare organizations ($438,000) and single-specialty group practices ($398,000). Last year, the same two practice settings were at the top, but their order was reversed. In 2015, anesthesiologists in single-specialty groups earned $429,000, and those in healthcare organizations earned $385,000.

This year, as in all previous years of the report, male anesthesiologists are earning more than their female counterparts. Male anesthesiologists made $372,000 and their female peers $317,000, a difference of $55,000. When asked about this disparity, Travis Singleton of Merritt Hawkins said, "The persistence of these disparities is puzzling because we see no contractual bias from our clients against female candidates." He observed that disparities may exist in work schedules, "particularly with younger female physicians who are in their peak child-rearing years and require flexible schedules, including part-time." It should be noted, however, that the compensation reported here is based on full-time positions.

Being employed or self-employed does not seem to have a role in the gender disparity in salary. Earnings for self-employed female anesthesiologists are $357,000, 86% of men's $413,000. Employed female anesthesiologists' compensation is $307,000, 91% of their male counterparts' $336,000. (Note: This chart includes full-time workers only but does not control for the number of hours worked.)

In 2010, 48% of medical degrees were earned by women. Given the growing physician shortage, it is interesting that a quarter of female anesthesiologists who responded to the survey work part-time compared with a mere 9% of men. Part-time is defined in this survey as working less than 40 hours per week.

Although slightly over half of anesthesiologists (55%) believe that they are fairly compensated, they are not the most dissatisfied physicians. Those who feel most underpaid are urologists (42%) and allergists and endocrinologists (both 43%). As in every year's survey since 2012, those who felt most fairly paid are dermatologists (66%), who are also the third highest earners this year. Pathologists (63%) and emergency medicine physicians (60%) followed in satisfaction, even though their earnings were toward the middle range among physicians.

The report this year looked at the difference in earnings of physicians who thought their compensation was fair versus that of their peers who did not. Not surprising is that, regardless of specialty, those who made more were more likely to feel fairly paid than those who made less. Anesthesiologists who believed that they were fairly paid made $44,000 more than their peers who believed that their compensation was unfair. And the more a specialty group earns, the greater the perceived disparity. Orthopedists, for example, are the highest-paid group; those who think that they are fairly paid make $156,000 more than those who find their compensation inadequate.

Nearly one half (48%) of employed male anesthesiologists and 58% of employed female anesthesiologists believe that they are fairly compensated, more than their self-employed male and female counterparts (45% and a far lower 27%, respectively).

Five years ago, in the 2011 Medscape report, 61% of anesthesiologists said they would choose medicine again and 70% would select the same specialty. This year, slightly fewer anesthesiologists (59%) would choose medicine, but far fewer (48%) would select their specialty. Furthermore, in 2011, 53% said they would choose their own practice setting, but this year a mere 24% would.

To determine the level of general career satisfaction, Medscape averaged the percentage of anesthesiologists who again would choose medicine, those who would choose their own specialty, and those who thought they were fairly compensated. At 54%, anesthesiologists fell slightly above the middle among all physicians—very close to last year's rank and percentage (53%). The most satisfied physicians this year are dermatologists (65%), oncologists (59%), and psychiatrists and pathologists (both at 58%). The two least satisfied groups are nephrologists (47%) and internists (48%).

Despite considerable attention, cash-only and concierge practices are still not significant payment models for any physicians, including anesthesiologists.^[4] This has not changed since last year. This year, only 3% of anesthesiologists were in concierge practices and 7% in cash-only. Travis Singleton of Merritt Hawkins observed that in order to avoid the pressure of private practice, the "escape hatch" for many physicians has been employment rather than changing to concierge medicine. However, he has seen a continual increase in the direct pay model and urgent care delivery. Anesthesiologist participation in accountable care organizations (ACOs) had been rising dramatically from year to year, but this year it increased only from 29% to 30%; moreover, only 6% of our anesthesiology respondents expect to join an ACO this year. According to some experts, as of late 2015, questions remain about whether meeting quality metrics translates into meaningful improvement.^[5]

Just over one quarter (26%) of anesthesiologists have seen an influx of patients due to the Affordable Care Act (ACA). A 2015 report analyzed how physicians viewed their ability to provide high-quality care a year after the implementation of the ACA.^[6] It found no association with lower- or higher-quality care whether or not patient load had increased. Among those who said quality had worsened, 21% had a higher patient load and 18% reported no increase. Over three quarters (78%) of physicians whose patient load increased said that quality had stayed the same or improved; 82% of those who experienced no increase reported the same experience.

This year, 83% of self-employed and 87% of employed anesthesiologists say they are continuing to take new and current Medicare and Medicaid patients. In both groups, these percentages are slightly higher than in the 2015 report (77% and 80%, respectively). In the current report, 5% of self-employed and 6% of employed anesthesiologists have stopped seeing their Medicare and Medicaid patients or are not taking new ones, which has scarcely changed from last year (5% and 7%, respectively).

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 compensation report, when anesthesiologists were asked whether they would drop insurers that pay poorly, only 6% said they would and 31% said they would not. (The question was not applicable to 63% of anesthesiologist respondents, most likely because many are employed.)

The authors of a 2013 editorial in the New England Journal of Medicine wrote, "Because treatments can be 'financially toxic,' physicians need to disclose the financial consequences of treatment alternatives just as they inform patients about treatments' side effects."^[7] In Medscape's current compensation report, 61% of anesthesiologists say they discuss the cost of treatment with patients, though only 13% do so regularly. Just over a quarter (26%) don't know the costs of their treatments, and 13% feel that such discussions are inappropriate.

One third of anesthesiologists spend 30-45 hours per week seeing patients, while far more (63%) spend more than that. According to a government analysis, middle-aged physicians work harder than both their younger and older peers.^[8] In fact, in the analysis, those between ages 46 and 55 work more hours now than they did in previous years, while younger doctors (36-45) work fewer hours than previously, perhaps because of the increase in women in those age groups, many of whom are working part-time.

Bureaucratic tasks were the prime cause of physician burnout, according to this year's Medscape Lifestyle Report (and in previous ones as well). Second was spending too many hours at work. Among anesthesiologists responding to this year's survey, one third of those who are self-employed and 35% of their employed peers spend 10 hours or more per week on paperwork and administrative tasks.

Some research has found that female physicians spend more time with patients.^[9] In Medscape's report, among all physicians, 41% of men spent 17 minutes or more with their patients compared with 49% of women. Among anesthesiologists, however, 51% of men and 44% of women spent 17 minutes or more with patients. Note: This slide applies to office-based physicians only.

More than one third (36%) of anesthesiologists believe that being good at what they do is a major source of satisfaction. Fewer cited making good money (21%) and relationships with patients (20%), while even fewer chose "making the world a better place" (10%) or pride in being a doctor (8%). Just 2% found nothing rewarding. In the comments section included with this survey question, helping others was frequently mentioned as a reward of the job, as was teaching and training. One anesthesiologist summed it up as "improving the quality of care that I provide and leading my group to do that as well."

As of February 2016, 12.7 million Americans selected plans through the Health Insurance Marketplace, about 4% of the US population.^[10] Data are limited on the number of physicians who are participating, however. Often they have no choice, and many may be locked out of networks.^[11] This year, 19% of anesthesiologists said they plan to participate in the exchanges, 27% do not, and the rest are still unsure.

It is not yet clear how the ACA affects physician income. Many variables will play a role in the ultimate results.^[12] One study from the Robert Wood Johnson Foundation reported a 3% increase in reimbursement in states that expanded Medicaid eligibility and an increase of 3.3% in nonexpansion states.^[13] When anesthesiologists who participated in health insurance exchanges last year were asked whether their income had been affected, 52% reported no change and 5% said it had increased. Forty-three percent experienced a decrease.