1. Darves B. Compensation in the physician specialties: mostly stable. October 3, 2014. NEJM Career Center. Accessed February 19, 2016.
  2. Petterson SM, Phillips RL Jr, Bazemore AW, Koinis GT. Unequal distribution of the U.S. primary care workforce. Am Fam Physician. 2013;87. Accessed February 19, 2016.
  3. Finnegan SC, Cheng N, Bazemore AW, Rankin JL, Petterson SM. The changing landscape of primary care HPSAs and the influence on practice location. Am Fam Physician. 2014;89: Accessed February 19, 2016.
  4. Ahmen H. Cash-only and concierge-based medicine: Roles in the health care payment landscape. Harvard Medical Student Review. January 3, 2015. Accessed February 21, 2016.
  5. Schroeder MO. Do accountable care organizations work? Hospital of Tomorrow. October 20, 2015. Accessed February 21, 2016.
  6. Hamel L, Doty MM, Norton M, et al. Experiences and Attitudes of Primary Care Providers Under the First Year of ACA Coverage Expansion. The Henry J. Kaiser Family Foundation and the Commonwealth Fund. June 18, 2015. Accessed February 21, 2016.
  7. Ubel PA, Abernethy AP, Zafar SY. Full disclosure--out-of-pocket costs as side effects. N Engl J Med. 2013;369:1484-1486. Accessed February 22, 2016.
  8. US Department of Health and Human Services. The Physicians Workforce. December 2008. Accessed February 15, 2016.
  9. Reese SM. Women MDs spend more time with patients: Does it matter? Medscape Business of Medicine. June 23, 2011. Accessed February 21, 2016.
  10. Centers for Medicare & Medicaid Services. Health Insurance Marketplace Open Enrollment Snapshot - Week 13. Accessed February 21, 2016.
  11. Leonard K. Doctors, hospitals say "no" to Obamacare plans. US News and World Report November 4, 2015 Accessed February 22, 2016.
  12. Page L. 8 ways that the ACA is affecting doctors' incomes. Medscape Business of Medicine. August 15, 2013. Accessed February 21, 2016.
  13. The ACA's Sustained Impact on Payer Mix at Medical Practices. Robert Wood Johnson Foundation. September 2015. Accessed February 21, 2016.

Contributor Information

Carol Peckham
Editorial Services
Art Science Code LLC
New York, New York

Disclosure: Carol Peckham has disclosed no relevant financial relationships.


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Medscape Plastic Surgeon Compensation Report 2016

Carol Peckham  |  April 1, 2016

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Slide 1

Plastic surgeons 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.)

Slide 2

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, plastic surgeons' was eighth from the top among all physicians, at $355,000, almost the same as in last year's compensation report ($354,000), when they ranked fifth highest. 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]

Slide 3

Plastic surgeons' compensation increased less than 1% this year, near the least 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' compensation remained stable. The rest of the physicians reported an increase. When asked what they attributed their increases to, most plastic surgeons cited an improved economy, new or increased marketing efforts, and the addition of new services or procedures. Others noted that they had worked more hours, received raises or promotions, or changed locations.

Slide 4

This year, the highest earnings for plastic surgeons were reported in the South Central ($421,000), Northwest ($405,000), and North Central ($391,000) regions, while the lowest were in the Southeast ($312,000) and Northeast ($325,000). 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."

Slide 5

Plastic surgeons who make the most are in office-based, multispecialty group practices ($497,000) and healthcare organizations ($480,000). Last year, plastic surgeons' earnings were highest in the same practice settings, though the order was reversed. Those in healthcare organizations earned $493,000, and those in multispecialty groups earned $423,000.

Slide 6

This year, as in all previous years of the report, male plastic surgeons are earning more than their female counterparts. Male plastic surgeons made $363,000 and their female peers $327,000, a difference of $36,000. 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.

Slide 7

Being employed or self-employed appears to play a small role in the gender disparity in plastic surgeons' salaries. Earnings for self-employed female plastic surgeons are $326,000, which is 86% of men's $381,000, and employed female plastic surgeons' compensation is $327,000, a nearly equitable 96% of their male counterparts' $340,000. (Note: This chart includes full-time workers only but does not control for the number of hours worked.)

Slide 8

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 plastic surgeons, only 15% of both men and women who responded to the survey work part-time. Part-time is defined in this survey as working less than 40 hours per week.

Slide 9

Although less than half of plastic surgeons (47%) 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.

Slide 10

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. Plastic surgeons who believed that they were fairly paid made $102,000 more than their peers who believed that their compensation was unfair. The more a specialty group earns, it appears, 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.

Slide 11

More than one third (39%) of employed male plastic surgeons and less than half (46%) of employed female plastic surgeons believe that they are fairly compensated, compared with higher percentages (59% and 54%, respectively) of their self-employed counterparts.

Slide 12

Five years ago, in the 2011 Medscape report, 62% of plastic surgeons said they would choose medicine again and 82% the same specialty. This year, significantly fewer would choose medicine (47%) or the same specialty (58%). Furthermore, in 2011, 53% said they would choose the same practice setting, but this year only 30% would do so.

Slide 13

To determine the level of general career satisfaction, Medscape averaged the percentage of plastic surgeons who again would choose medicine, those who would choose their own specialty, and those who thought they were fairly compensated. At 51%, plastic surgeons ranked below the middle among physicians. In last year's report, at 50%, their rank was about the same. According to the calculation, this year, the least satisfied are nephrologists (47%) and internists (48%). The most satisfied physicians are dermatologists (65%), followed by oncologists (59%) and psychiatrists and pathologists (both at 58%).

Slide 14

Despite considerable attention, cash-only and concierge practices are still not significant payment models for any physicians. Among plastic surgeons, however, while concierge practices are rare, cash-only is the dominant payment model.[4] This has not changed since last year. This year, only 4% of plastic surgeons were in concierge practices and 41% were in cash-only, compared with 5% and 36% last year. 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. Plastic surgeon participation in accountable care organizations (ACOs) had been rising dramatically from year to year, but this year it increased only from 26% to 27%; moreover, only 3% of plastic surgery respondents expect 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]

Slide 15

Eighteen percent of plastic surgeons 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.

Slide 16

This year, only 39% of self-employed but a far higher 82% of employed plastic surgeons say they are continuing to take new and current Medicare and Medicaid patients. Among self-employed plastic surgeons, the percentage has decreased from 45% since the 2015 report. In contrast, the percentage has increased among employed plastic surgeons from 74%. In the current report, more than one third (36%) of self-employed but only 7% of employed plastic surgeons have stopped seeing their Medicare and Medicaid patients or are not taking new ones. This represents an increase from last year among self-employed plastic surgeons and a slight decrease for those who are employed (27% and 8%, respectively).

Slide 17

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 plastic surgeons were asked whether they would drop insurers that pay poorly, 16% said they would and 31% said they would not. (The question was not applicable to 53% of plastic surgeon respondents, most likely because many are employed.)

Slide 18

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, 91% of plastic surgeons say they discuss the cost of treatment with patients and 53% do so regularly. Just three percent do not discuss costs because they don't know them, and 7% do not because they feel that such discussions are inappropriate.

Slide 19
Slide 20

Just under one half (49%) of plastic surgeons spend 30-45 hours per week seeing patients, and 36% 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.

Slide 21

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 plastic surgeons responding to this year's survey, 56% of those who are self-employed and 62% of their employed peers spend 10 hours or more per week on paperwork and administrative tasks.

Slide 22

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 significantly greater among plastic surgeons: 55% of men and 78% of women spent 17 minutes or more with patients. Note: This slide applies to office-based physicians only.

Slide 23

Forty-one percent of plastic surgeons believe that relationships with patients are a major source of satisfaction, and 29% cited being very good at their job. These answer choices garnered the most votes by far. "Making good money at a job that I like" was selected by 14% and "making the world a better place" by only 7%. Three percent found nothing rewarding. In the comments section included with this survey question, teaching and helping patients were mentioned as rewards of the job.

Slide 24

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, only 10% of plastic surgeons said they plan to participate in the exchanges, 57% do not, and the rest are still unsure.

Slide 25

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 plastic surgeons who participated in health insurance exchanges last year were asked whether their income had been affected, 47% reported no change and 11% said it had increased. Forty-two percent experienced a decrease.

Slide 26
Slide 27
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