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References

  1. Obamacare Facts. How Will ObamaCare Affect Your Small Business? http://obamacarefacts.com/obamacare-small-business/ Accessed October 18, 2015.
  2. Henry J. Kaiser Family Foundation. 2015 Employer Health Benefits Survey. September 22, 2015. http://kff.org/report-section/ehbs-2015-summary-of-findings/ Accessed October 18, 2015.
  3. Mui YQ. Companies have found something to give their workers instead of wages. July 28, 2015. The Washington Post. http://www.washingtonpost.com/news/wonkblog/wp/2015/07/28/companies-have-found-something-to-give-their-workers-instead-of-raises/ Accessed October 15, 2015.
  4. Bureau of Labor Statistics. May 2014 National Occupational Employment and Wage Estimates: United States. Healthcare Support Occupations. http://www.bls.gov/oes/current/oes_nat.htm#31-0000 Accessed October 15, 2015.
  5. Japsen B. Smooth Rollout for New ICD-10 Medical Codes, Insurers Say. Forbes. October 13, 2015. http://www.forbes.com/sites/brucejapsen/2015/10/13/so-far-smooth-rollout-for-new-icd-10-medical-codes-insurers-say/ Accessed October 18, 2015.
  6. Frellick M. SGR Replacement Has Potential Pitfalls as Well. Medscape Medical News. September 24, 2015. http://www.medscape.com/viewarticle/851457 Accessed October 21, 2015.
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Contributor Information

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

Disclosure: Carol Peckham has disclosed no relevant financial relationships.

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Sarah Grisham, JD
Freelance writer
Albuquerque, New Mexico

Disclosure: Sarah Grisham, JD, has disclosed no relevant financial relationships.

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Close<< Medscape

Clinical and Office Staff Salary Report 2015

Carol Peckham  |  October 28, 2015

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Slide 1

Medscape asked physicians to tell us how much they pay their staff, what benefits and raises they give, and what positions will be added and cut in the coming year. More than 1050 physicians across 25 specialties described their practice and staff situations.

Image from iStock

Slide 2

Nonphysician clinical and administrative staff include clinical staff (nurse practitioners, registered nurses, physician assistants, and medical assistants) and nonclinical staff (front desk, medical billers, medical coders, medical coder/billers, and medical records clerks). Few practices manage with only one employee, and most practices employ two to five nonphysician clinicians and administrative staff. Fifty percent of respondents report more than six in their practice. The chart above includes the total of full-time and part-time staff members.

Slide 3

Looking at nonclinical staff, 98% of physician practices have either full- (78%) or part-time (20%) front-desk staff. The rate of full-time members of this staff is down from Medscape's 2013 survey (84%). (The earlier report did not show part-time staff members.) The current survey includes coders as a category, which was not present in 2013; 21% of physician practices reported hiring full- or part-time dedicated coders, and 42% employed staff who handled both billing and coding. Forty-two percent employ billers only. The percentage of practices employing a full-time medical records clerk remained steady at 25% between 2013 and 2015.

Among all clinical positions, practices are most likely to hire medical assistants (85%). About two thirds (67%) employ full-time medical assistants, a slight increase from 65% in 2013. This year, 29% of physician practices employed full-time registered nurses, and 27% had full-time nurse practitioners on staff, down from 37% and 31%, respectively, in 2013. In contrast, the percentage of full-time physician assistants rose slightly, from 24% in 2013 to 26% this year.

Slide 4

There is little difference between primary care physicians (PCPs; general and family physicians and internists) and specialists in the full- and part-time staff they employ. The most notable distinctions are in medical assistants, with 74% of PCP practices and 62% of specialist practices employing them, while more specialists (31%) than PCPs (25%) have registered nurses on staff. Slightly more specialists' practices (19%) than PCPs' (16%) have hired medical coders.

Slide 5

Practices in which physicians employ staff report employing an average of three to five nonclinical staff members and five to seven clinical staff, with medical assistants (five full time and two part time) and registered nurses (four and two, respectively) employed in the greatest numbers across practices.

Slide 6

Of little surprise, most clinical staff members (nurses and medical and physician assistants) are more highly paid than nonclinical staff. Nurse practitioners receive $87,000 in compensation, followed closely at $85,000 for physician assistants. Registered nurses are third at $52,000. Of interest, however, among the clinical staff, medical assistant compensation ($30,000) is lower than that of a medical biller/coder ($37,000), indicating the current importance of this latter position, possibly because of the ICD-10 challenges. Medical records clerks received the lowest average annual pay at $26,500, with front-desk staff at a slightly higher salary of $28,000.

Slide 7

Physician practices are providing benefits to full-time nonphysician and administrative staff at virtually the same rates they did in the 2013 survey. Though the Affordable Care Act (ACA) gives smaller practices the opportunity to receive tax incentives for making health insurance available to their employees,[1] there was a decrease in paid health insurance: only 68% in the 2013 survey and even less (65%) this year. It should be noted, however, that these percentages are still higher than the national current health benefits rates for small business in general (57%).[2] Similar decreases were seen between 2013 and 2015 in practices providing health savings accounts (26% and 23%, respectively) and retirement plans with no employer match (22% and 19%, respectively). Four percent received "other" benefits, which, according to this year's respondents, include reimbursement for tuition and professional fees, profit-sharing, gym memberships, and discounts on a practice's services.

Slide 8

Slightly more physician practices reported giving annual raises to nonphysician and administrative staff in the 2015 survey (73%) than in 2013 (70%). Although the increase is slight, the results on both raises and benefits in the Medscape survey run counter to the national trend of increasing benefits rather than giving raises.[3]

Slide 9

In this year's Medscape survey, just over half of physician respondents who give raises reported average annual increases of 1%-2% (52%), while 43% gave 3%-5%. The minimum annual staff increase given by nearly 79% of these physicians was between 1% and 2%, with 58% reporting a maximum raise of 3%-5%. According to the Bureau of Labor Statistics in 2014, the average increase in wages among healthcare providers and those in healthcare support occupations was much lower (0.2%) than reported here.[4] Government data on industry in general has reported only a 2% increase in wages since 2004.[3]

Slide 10

The most important factor by far to physician practices in determining raises is good job performance, with over half (55%) placing this in the top two rankings for importance. When looking at the top two, hard work came next at 33%, and positive attitude was third at 29%. Less important factors include reliability and likeability among patients (15% chose top two ratings for both). Low salary and willingness to work extra hours are the least important factors.

Slide 11

The percentage of respondents who say they do not plan any changes in the number of nonphysician staff they employ decreased from 67% in the 2013 Medscape survey to 63% this year. The decrease is happily due to an increase in the percentage of respondents who plan to add staff in the coming year (24%, up from 17% in 2013) and a decrease in those who plan to cut staff (6%, down from 9% in 2013). There was no change from 2013 in the percentage of physicians who plan to both add and cut staff (steady at 7%).

Slide 12

ICD-10 compliance was required by October 1, 2015. Within the first 2 weeks of launch, large insurers were reporting that the transition was going fairly smoothly.[5] A large majority (81%) of respondents said that they do not intend to hire additional staff to handle tasks related to ICD-10. Among those who will be hiring, 9% will hire one part-time employee, 6% will hire one full-time employee, and only 2% will hire more than one employee. An additional 4% of respondents will hire one or more employees to perform ICD-10 tasks, but half of them will also eliminate one or more positions to maintain staff size. Two years ago, only 14% were concerned enough about ICD-10 to hire more staff.

Slide 13

Among respondents in this year's survey who plan to add full-time nonphysician staff, most are looking for clinical assistance; 38% intend to hire medical assistants, 30% nurse practitioners, and 23% physician assistant. Only 12%, however, were looking for registered nurses. The percentages for clinical staff do not differ significantly from the 2013 survey (40%, 29%, 27%, and 14%, respectively). Among nonclinical staff, only front-desk clerks are in the top four at 28%. Medical records clerks are at the bottom of the hire list at 2%. Perhaps in response to the ICD-10 mandate plus the impact of the ACA on insurance processing, a combined 27% of respondents say that they will add medical billers/coders (13%), coders (8%), and just billers (6%). One can assume that 21% need coders and 19% need more billers. This is an increase from the 2013 Medscape survey, when 12% planned to hire medical billers, and about a third of respondents planned to cut this staff. (This year only 13% of practices are getting rid of their billers.)

Slide 14

Among physician practices planning full-time staff cuts, nearly as many intend to cut front-desk staff (26%) as add it (28%). Nevertheless, the job loss in this group is much lower than in 2013, when 45% of physicians said that they would cut this position. Medical assistants are at a slightly greater advantage. About a quarter (24%) of respondents intend to cut medical assistants, but, as with front-desk clerks, this is a far lower percentage than those cut in 2013 (40%). One can guess that the practice needs for these positions have now leveled off. Only 8% of respondents plan to cut either nurse practitioners or medical records clerks. A combined 13% of respondents plan cuts to billers (billers alone or billers/coders), which is a dramatic decrease from the 33% of 2013 respondents who planned such cuts among these professionals. Only 8% are losing coders (alone or with jobs that combine billing). Among the 20% of respondents who intend to cut "other" staff, several cited managers and office managers and licensed practice and unspecified "nurses".

Slide 15

Ensuring adequate staffing to manage the workload, current and predicted, is the predominant concern among respondents who plan to add full-time nonphysician providers and administrative staff. Forty-five percent recognize that their current staffs simply aren't large enough to manage the work. Of interest, in the 2013 survey 2 years ago, 47% said that they were adding staff in anticipation of the ACA. This year, patient volume from the ACA is responsible for adding staff in only 18% of practices, while 42% said that they needed staff for more patients unrelated to the ACA. Other significant reasons for hiring among respondents who plan to add staff are employee turnover and transitioning to ICD-10, both at 24%. Twenty-one percent of these respondents cited the need to increase patient volume to offset declining reimbursements.

Slide 16

Clearly the most important reason for cutting staff is due to declining reimbursements from insurers. Of interest, there was very little difference in percentages between private and government payers. Thirty-nine percent accused commercial payers and 36% government payers for declining reimbursement, and 42% selected both as a reason for cutting staff. (Because physicians were able to choose as many options as they wanted from this question, there was some overlap among these responses.) Although the universally loathed Sustainable Growth Rate Formula was replaced in April, it is still uncertain if the new changes in reimbursement will increase practice income significantly in the future.[6] Twenty-three percent of respondents are hiring part-time or remote employees for other support services, and 17% are outsourcing them. Twelve percent of respondents plan to cut staff as a result of transitioning to ICD-10.

Slide 17

Factors involved in determining whether or not survey respondents retain staff are ranked similarly to those cited for allocating raises. Over half (52%) of physicians gave the top two ratings in importance for keeping staff to good job performance followed by 33% for hard work. These are also the top two areas of importance in giving raises (55% and 33%, respectively). Percentages for other factors also did not differ much for reasons to give raises or keep staff. Although over half (57%) thought being likeable by patients was a reason for keeping a staff member, only 14% put this as first or second in importance. Unique skills and willingness to work extra hours were the least important factors to 2015 respondents. Only 4% and 1%, respectively, chose these as most important factors.

Slide 18

When considering whether to cut staff, performance was still ranked as the top reason to cut a staff member, with 42% of physicians putting this in the top two ratings. More than a third (36%) ranked importance of the job in the practice as one or two. Hard work and a positive attitude are also significant first and second considerations, at 28% and 25%, respectively. These assets are also consistently listed as alternative choices. Likeability among patients was not a popular first or second choice (11%). Unique skills, low salary, and willingness to work extra hours are the least important factors among respondents considering staff cuts, with low percentages citing these assets as alternative choices.

Slide 19

The vast majority (76%) of respondents believe that they have good relationships with members of their staffs. An additional 23% of respondents have good relationships with staff members on the whole, but with one or two exceptions. A mere 1% of respondents say they don't pay much attention to these relationships.

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