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Carol Peckham | April 18, 2018 | Contributor Information
The Medscape Physician Compensation Report is the most comprehensive and widely used physician salary survey in the United States for the eighth year in a row. Anesthesiologists who responded to this year's survey disclosed not only their compensation but also how many hours they work per week, how many minutes they spend with each patient, what they find most rewarding—and challenging—about their work, and more. (Some totals in this presentation do not equal 100% due to rounding.)
Carol Peckham | April 18, 2018 | Contributor Information
Survey respondents were asked to provide their annual compensation for patient care. For employed physicians, that includes salary, bonus, and profit-sharing contributions. For partners, it includes earnings after taxes and deductible business expenses before income tax. Plastic surgeons, orthopedists, and cardiologists were among the top earners this year. Anesthesiologists were also among the higher earners. This year's lowest-earning specialties were the same as they were 5 years ago in Medscape's 2013 Compensation Report.
Carol Peckham | April 18, 2018 | Contributor Information
Compensation for anesthesiologists increased this year. The greatest increases were seen among psychiatrists, plastic surgeons, and physiatrists. Medscape's results align with industry data regarding psychiatry. "We have never seen demand for psychiatrists this high in our 30-year history," says Tommy Bohannon of Merritt Hawkins, a physician recruiting firm. "Demand for mental health services has exploded, while the number of psychiatrists has not kept pace."
Decreases in earnings were evident in only six specialties this year, with general surgery and urology among the hardest hit.
Carol Peckham | April 18, 2018 | Contributor Information
Where a physician attended medical school can be a factor in future earnings. Some graduates of US medical schools are American citizens who studied outside of the United States; others grew up in the country where they went to medical school and moved to the United States to practice. Average compensation for US-trained anesthesiologists exceeds that reported this year by their foreign-trained peers.
Carol Peckham | April 18, 2018 | Contributor Information
Among anesthesiologists there is a disparity in gender inclusion, with men generally outnumbering women across races and ethnicities. The difference is more pronounced among some racial or ethnic groups.
Carol Peckham | April 18, 2018 | Contributor Information
Anesthesiologists who are employed earn less than those who are self-employed, presuming they will trade a higher salary for a steadier income and less time focusing on running a business. According to a survey from the Physicians Foundation, however, employment does not necessarily reduce nonclinical workload.[1]
Carol Peckham | April 18, 2018 | Contributor Information
More anesthesiologists are now employed rather than self-employed. This reflects a national trend toward physician employment, as hospitals and other entities have consolidated and absorbed private practices, and younger physicians have sought a steadier income stream and more regular hours. There is some indication, however, that the trend has plateaued, as hospitals reach staffing limits.[2]
Carol Peckham | April 18, 2018 | Contributor Information
This year, as in all previous years, the male anesthesiologists Medscape surveyed reported higher earnings than did their female counterparts. Although women are more likely to work part-time, which would give them a lower average income, this report uses full-time salaries for compensation, so part-time work does not account for the difference.
Carol Peckham | April 18, 2018 | Contributor Information
More female anesthesiologists are employed than are their male peers. This difference may account for some of the disparity in income between the two groups.
Carol Peckham | April 18, 2018 | Contributor Information
Percentages of part-time female and male physicians have varied somewhat over the years, with 22% of women and 12% of men reporting this year that they work fewer than 30 hours per week. There are differences among physician groups, however. Among anesthesiologists surveyed, a smaller percentage of women and men work part-time than among the averages for all physicians.
Carol Peckham | April 18, 2018 | Contributor Information
All anesthesiologists, whether employed or self-employed, were asked about their benefits this year. The highest percentages said they receive liability coverage, employer-subsidized health insurance, paid time off, and dental coverage. Just over one tenth of anesthesiologists reported that they receive no benefits.
Carol Peckham | April 18, 2018 | Contributor Information
About two thirds of anesthesiologists surveyed believe that they are fairly compensated, which places them slightly above the middle among other physicians. Specialists' satisfaction does not always coincide with their compensation relative to other physicians. For example, plastic surgeons were among the least satisfied with their compensation despite being among the highest paid. Conversely, public health physicians reported relatively low compensation but were among the most satisfied with their pay.
Carol Peckham | April 18, 2018 | Contributor Information
This year, the Medscape survey asked physicians who reported that they are not satisfied with their compensation how large an increase they feel they deserve. Close to one half of anesthesiologists feel that they should be earning 11% to 25% more, and nearly one third feel that they deserve an increase of 26% to 50%.
Carol Peckham | April 18, 2018 | Contributor Information
The large majority of anesthesiologists reported that they are paid through an insurance carrier, with about two fifths saying they are reimbursed on a fee-for-service basis. Just over one quarter said they are paid through accountable care organizations (ACOs), which is one of the advanced alternative payment systems under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). A small percentage reported that they have adopted the direct primary care model, which is gaining popularity compared with concierge and cash-only models among physicians whose practices allow direct pay.[3]
Carol Peckham | April 18, 2018 | Contributor Information
Since MACRA was implemented, there have been numerous changes in the Merit-based Incentive Payment System (MIPS), one of CMS's two Quality Payment Programs (QPPs), and more are anticipated. The changes have created confusion and frustration among physicians, and some would like to see MIPS significantly reformed, if not replaced. Anesthesiologists reported participation in MIPS that was around the middle relative to all physicians surveyed.
Carol Peckham | April 18, 2018 | Contributor Information
The other QPP introduced by CMS, Alternative Payment Models (APMs), is generally implemented in large organizations, generally through CMS initiatives. Anesthesiologists reported a participation rate around the middle among physicians in this payment model, with participation overall lower in APMs than in MIPS.
Carol Peckham | April 18, 2018 | Contributor Information
In this year's survey, a minority of anesthesiologists said they would drop insurers that pay poorly. One quarter said they would not because they need all payers.
Carol Peckham | April 18, 2018 | Contributor Information
In spite of billing and other administrative challenges, most anesthesiologists surveyed said they will continue to take Medicare and Medicaid patients. Still, 12% of anesthesiologists indicated they would stop treating these patients, and another 16% said they have not yet decided.
Carol Peckham | April 18, 2018 | Contributor Information
Increases in the number of physicians reporting that they participate in health insurance exchanges have stabilized since their introduction in 2014, and there is almost no change from last year's survey in the percentage of participating anesthesiologists. Nearly one half, however, remain unsure about whether they will participate.
Carol Peckham | April 18, 2018 | Contributor Information
Anecdotally, physicians have complained about the effect of the Affordable Care Act on their incomes, and results from this year's survey bear those concerns out for about one fifth of anesthesiologists.
Carol Peckham | April 18, 2018 | Contributor Information
Healthcare continues to cause financial worry among Americans, but there is little guidance for physicians about how to discuss costs with their patients. Barriers include unfamiliarity with patients' insurance or financial status and even the cost of the treatments they recommend.[4] Given that anesthesiologists are typically in contact with patients as part of a team, it's not surprising that only 15% reported that they regularly have such discussions with their patients.
Carol Peckham | April 18, 2018 | Contributor Information
Physicians say that instituting a no-show policy helps them avoid overscheduling in order to ensure that all time slots are filled. However, this policy is less relevant for anesthesiologists than for many other specialties.
Carol Peckham | April 18, 2018 | Contributor Information
Whereas more than a third of anesthesiologists reported that they spend 30 to 45 hours each week with patients, well over half said they spend more than 45 hours. The latter percentage, however, is lower than in the two prior years' reports.
Carol Peckham | April 18, 2018 | Contributor Information
Medscape asked physicians about the time they themselves—not a physician assistant, nurse, or medical assistant—spend with each patient. As expected, more than one quarter of anesthesiologists spend at least 25 minutes with individual patients.
Carol Peckham | April 18, 2018 | Contributor Information
Bureaucratic tasks remain the primary cause of burnout among physicians, and almost one half of anesthesiologists reported this year that they spend 10 hours or more per week on paperwork and administration.
Carol Peckham | April 18, 2018 | Contributor Information
Getting promoted in a hospital, clinic, or large group setting typically adds administrative and/or management responsibilities to a physician's job. Such factors may play a role in the fact that less than one half of employed anesthesiologists said they are seeking promotion.
Carol Peckham | April 18, 2018 | Contributor Information
Among anesthesiologists, more women than men reported this year that they are seeking promotion within their organization. "It's possible that more male doctors already are in leadership positions and female physicians are anxious to catch up," says Tommy Bohannon. "Another factor may be that moving to a full-time or part-time administration role can lead to greater schedule flexibility and better work-life balance."
Carol Peckham | April 18, 2018 | Contributor Information
Anesthesiologists most often named making good money and being very good at what they do as the most rewarding aspect of their job, followed by making the world a better place and relationships with and gratitude from patients. A very small percentage cited teaching.
Carol Peckham | April 18, 2018 | Contributor Information
Having to work long hours was most cited as one of the most challenging parts of an anesthesiologist's job. Very few named concern over being sued or having to work with an EHR system.
Carol Peckham | April 18, 2018 | Contributor Information
Despite all of the current challenges, just over three quarters of anesthesiologists said that they would choose medicine again. The financial rewards and being good at what they do appear to make up for the difficulties they face in their jobs.
Carol Peckham | April 18, 2018 | Contributor Information
Of those who would choose medicine again, anesthesiologists fall about in the middle of physicians who would choose their specialty again if given the opportunity to do so.
More than 20,000 physicians told us how much they earn, how many hours they work, and whether they're satisfied with their compensation.Slideshows, April 2018
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Contributor Information
Carol Peckham
Editorial Director Art Science Code
Disclosure: Carol Peckham has disclosed no relevant financial relationships.
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References + More on Methodology
References
Survey of America's Physicians: Practice Patterns and Perspectives. Boston: The Physicians Foundation/Merritt Hawkins; 2014.
Kane CK. Updated data on physician practice arrangements: physician ownership drops below 50 percent. American Medical Association. Policy Research Perspectives. 2017. Article. Accessed March 26, 2018.
Davis J. States move to enable direct primary care as a new approach to health care services. The Council of State Governments. January 25, 2018. Article. Accessed March 26, 2018.
Ganos G. Costs of care: getting the patient-provider conversation right. Culture of Health Blog. Robert Wood Johnson Foundation. June 15, 2016. Article. Accessed March 26, 2018.
More on Methodology
Survey invitations were emailed to Medscape member physicians from November 21, 2017 to February 21, 2018. Respondents were invited to participate in an online study of "Physician Compensation and Net Worth." Members who completed the survey were entered into a sweepstakes that awarded 50 random winners a $150 Amazon.com gift card.
Respondents were required to be physicians currently practicing in the United States. The total sample size was 20,329. The overall margin of sampling error for this survey was ± 0.69% at a 95% confidence level using a point estimate of 50%. Statistical difference from 50% is the most conservative in measuring sample error.
Other factors may also contribute to error in survey estimates, including measurement error, construct and content validity, question wording, and question order. Standard quality-control measures included checking for clear question wording, proper question ordering, and use of appropriate scales and response categories. In addition, during the field period, the survey was checked to make certain that respondents were answering all questions logically and that skip-pattern programming was working properly.
The final data were cleaned to ensure data quality. Full-time respondents were weighted to reflect the American Medical Association's physician distribution by specialty, state, and gender.
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