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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018
| Contributor Information
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Medscape Family Physician Compensation Report 2018
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. Family physicians 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.)
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Medscape Family Physician Compensation Report 2018
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. Cardiologists were among the top earners this year along with plastic surgeons and orthopedists. This year's lowest-earning specialties, which included family medicine, were the same as they were 5 years ago in Medscape's 2013 Compensation Report.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Compensation for family physicians increased slightly 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.
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Medscape Family Physician Compensation Report 2018
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. Little difference was observed in compensation between foreign- and US-trained family physicians.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Among family physicians there is an observed gender disparity in some racial or ethnic groups. Among African American/black family physicians and those of mixed ethnicities, there are more women than men, while in all other groups, male family physicians outnumber their female peers.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
The difference in compensation between employed and self-employed family physicians is small. Being employed offers 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]
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Far more family physicians 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]
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
This year, as in all previous years, the male family physicians who 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 would not account for the difference.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
More female family physicians are employed than are their male peers. This difference is not large but it may account for some of the disparity in income between the two groups.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
The percentage of total part-time female and male physicians has varied somewhat over the years, with 22% of women and 12% of men working fewer than 30 hours per week. A similar difference is observed among family physicians.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
The great majority of family physicians this year say they receive liability coverage and employer-subsidized health insurance. About three quarters receive employer-subsidized dental insurance, and around two thirds have paid time off, retirement plans with employer matches, and vision insurance. Very few family physicians reported that they receive no benefits. Note that all family physicians, whether employed or self-employed, were asked about their benefits.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
About three fifths of family physicians surveyed believe that they are fairly compensated, falling slightly above the middle in satisfaction among all physicians. Satisfaction in a physician group does not always coincide with their compensation relative to other groups. 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.
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Medscape Family Physician Compensation Report 2018
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. Over two fifths of family physicians feel that they should be earning 11% to 25% more, and over a third feel that they deserve 26% to 50% more.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Over two thirds of family physicians reported that they are paid through an insurance carrier, followed by fee-for-service, used by 44%. Under a third say they receive their pay 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). Only slightly under a quarter have adopted the direct primary care model, which is gaining popularity among primary care physicians.[3]
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Medscape Family Physician Compensation Report 2018
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. Family physicians reported participation in MIPS around the middle relative to all physicians surveyed.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
The other QPP introduced by CMS, Alternative Payment Models (APMs), is generally implemented in large organizations, including demonstration programs, ACOs, and other CMS initiatives. Family physicians reported participation rates in this payment model about in the middle compared with other physicians, although overall participation is lower with APMs than with MIPS.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
In this year's survey, a minority of family physicians said they would drop insurers that pay poorly. About one fifth said they needed all the payers they could get.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
In spite of billing and other administrative challenges, most family physicians surveyed said they will continue to take Medicare and Medicaid patients. Fourteen percent were undecided, and the remaining responses were some combination of not taking new or dropping patients on Medicaid, Medicare, or both.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Increases in the number of physicians reporting that they participate in health insurance exchanges had been stabilizing since their introduction in 2014, but this year's Medscape survey saw a decrease to 36% from last year's 43% in family physicians who reported that they participated in the exchanges. A fair number—and higher than reported in the previous year—are unsure about whether they will participate.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Physicians overall have complained about the effect of the Affordable Care Act on their incomes, and results from this year's survey suggest that only 9% of family physicians who participate in an exchange have experienced a decrease.
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Medscape Family Physician Compensation Report 2018
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] Even so, nearly all family physicians reported that they occasionally or regularly have such discussions with their patients.
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Medscape Family Physician Compensation Report 2018
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. Most family physicians, however, reported that they do not charge patients who miss an appointment without providing notification.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
About two thirds of family physicians reported that they spend 30 to 45 hours each week with patients, while under one quarter spend more than 45 hours, which is similar to the percentages reported in the previous year's report.
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Medscape Family Physician Compensation Report 2018
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. The majority of family physicians reported that they spend between 13 and 24 minutes.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Bureaucratic tasks remain the primary cause of burnout among physicians, and over three quarters of family physicians reported this year that they spend 10 hours or more per week on paperwork and administration.
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Medscape Family Physician Compensation Report 2018
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 slightly less than two fifths of employed family physicians seeking promotion, according to this year's survey.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Among family physicians, 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."
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Family physicians most often named relationships with and gratitude from patients as the most rewarding aspect of their job, followed by making the world a better place and being very good at what they do. Only 1% could not find anything positive about their job.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Given the current upheaval in the healthcare system, it is no surprise that "having so many rules and regulations" was most often cited as the most challenging part of a family physician's job, followed by working long hours, dealing with electronic health records, and dealing with difficult patients. Worrying about being sued is not a large issue for most family physicians. Only 10% named difficulties getting fair reimbursement.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
Although family physicians were less likely than other specialists to say that they would choose medicine again, nearly three quarters reported that they would. The rewards of treating patients and having many of them express appreciation, and knowing that they are competent in their field and contributing to a better world, appears to make up for the difficulties they face in their jobs.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
As in previous years, family physicians are near the bottom of physicians who would choose their specialty again if given the opportunity to do so.
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
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Medscape Family Physician Compensation Report 2018
Carol Peckham | April 18, 2018 | Contributor Information
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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Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
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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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