Endocrinologists 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, endocrinologists were second from the bottom ($206,000), but their compensation was still higher than in last year's compensation report ($196,000), when they were third from the bottom. 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]

Endocrinologists had a 5% increase in income this year, about in the middle 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, most endocrinologists responded that they were working more hours. A few had experienced an increase in patient volume. Others simply received raises or had changed jobs or positions.

This year, the highest earnings for endocrinologists were reported in the West ($233,000), South Central ($220,000), and the Great Lakes ($212,000), while the lowest were in the Northwest ($169,000) and Southwest ($185,000). 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."

Endocrinologists who make the most are in office-based single-specialty groups ($228,000) and healthcare organizations ($219,000). Lowest earners are in hospitals ($155,000). Last year, earnings were also highest for endocrinologists in office-based single-specialty groups ($222,000), and the next highest earners were in outpatient clinics ($208,000), which came in fifth this year.

This year, as in all previous years of the report, male endocrinologists are earning more than their female counterparts. Male endocrinologists made $216,000 and their female peers $189,000, a difference of $27,000. 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 may have a role in the gender disparity in salary. Earnings for self-employed female endocrinologists are $193,000, which is 82% of men's ($236,000), and employed female endocrinologists' compensation is $186,000, which is 90% of their male counterparts' ($206,000). (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 over a quarter of primary care female physicians are part-time. However, among endocrinologists who responded to the survey, only 13% of women work part-time compared with even fewer men (5%). Part-time is defined in this survey as working less than 40 hours per week.

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. Endocrinologists who believed that they were fairly paid made $56,000 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.

About two thirds (66%) of employed male endocrinologists and three quarters of employed female endocrinologists believe that they are fairly compensated, compared with only 33% and 22%, respectively, of their self-employed counterparts.

Five years ago, in the 2011 Medscape report, 69% of endocrinologists said they would choose medicine again and 68% would select their own specialty. This year, fewer endocrinologists (60%) would choose medicine, and even fewer (45%) would select their own specialty. Furthermore, in 2011, 53% said they would choose their own practice setting, but this year only 21% would go that same route.

To determine the level of general career satisfaction, Medscape averaged the percentage of endocrinologists who again would choose medicine, those who would choose their own specialty, and those who thought they were fairly compensated. At 49%, endocrinologists are third from the bottom, tied with allergists in overall career satisfaction, very similar to last year's situation—50%, when they were fifth from the bottom. According to the calculation, the most satisfied physicians this year are dermatologists (65%), followed by oncologists (59%) and psychiatrists and pathologists (both at 58%).

Despite considerable attention, cash-only and concierge practices are still not significant payment models for any physicians.^[4] In fact, for endocrinologists, cash-only practices have decreased since last year, from 7% to 4%, and concierge practices from 4% to 1%. 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. Endocrinologist participation in accountable care organizations (ACOs) had been rising dramatically from year to year, and this year it increased from 32% to 43%, with only 4% of endocrinology respondents expecting to join an ACO this year. According to some experts, however, as of late 2015, questions remain about whether meeting quality metrics in ACOs translates into meaningful improvement.^[5]

Thirty-eight percent of endocrinologists 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, 63% of self-employed and 85% of employed endocrinologists say they are continuing to take new and current Medicare and Medicaid patients. Among the self-employed, this percentage is considerably higher than in the 2015 report (56%), while it was similar for the employed (84%). In the current report, 19% of self-employed and only 4% of employed endocrinologists have stopped seeing their Medicare and Medicaid patients or are not taking new ones, a decrease from last year among the self-employed (26%).

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 endocrinologists were asked whether they would drop insurers that pay poorly, 9% said they would and 39% said they would not. (The question was not applicable to 52% of endocrinologist 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, 93% of endocrinologists say they discuss the cost of treatment with patients and 45% do so regularly. Four percent don't know the costs of their treatments, and only 2% of endocrinologists feel that such discussions are inappropriate.

Nearly two thirds (62%) of endocrinologists spend 30-45 hours per week seeing patients, and only 27% 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 endocrinologists responding to this year's survey, 75% of those who are self-employed and 64% 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. The difference is much greater among endocrinologists: 52% of men and 81% of women spent 17 minutes or more with patients. Note: This slide applies to office-based physicians only.

Over a third of endocrinologists believe that relationships with patients (36%) or being very good at their job (35%) is a major source of satisfaction. "Making the world a better place" was selected by 11% and "making good money" by only 9%. Two percent found nothing rewarding. In the comments section included with this survey question, teaching was frequently mentioned as a reward of the job, as was helping others.

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, 21% of endocrinologists said they plan to participate in the exchanges, 23% don't, 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 endocrinologists who participated in health insurance exchanges last year were asked whether their income had been affected, 71% reported no change and 16% said it had increased. Thirteen percent experienced a decrease.