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Medscape Nephrologist 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. Nephrologists 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 Nephrologist 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. Nephrologists fell below the middle. Plastic surgeons, orthopedists, and cardiologists were among the top earners this year. This year's lowest-earning specialties were the same as they were 5 years ago in Medscape's 2013 Compensation Report.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Compensation for nephrologists 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.

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Medscape Nephrologist 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. Average compensation for US-trained nephrologists exceeds that reported this year by their foreign-trained peers.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Among nephrologists there is a disparity in gender inclusion, with men generally outnumbering women across ethnicities. The difference is more pronounced among some racial or ethnic groups. The gap between Caucasian/white male and female nephrologists, for example, is wider than that between their Asian male and female peers. Other racial groups were represented by too low a percentage of respondents to be included in this comparison.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Nephrologists 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]

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Far more nephrologists 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 Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

This year, as in all previous years, the male nephrologists 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.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

More male nephrologists are employed than are their female peers, so this difference does not account for the disparity in income between the two groups.

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Medscape Nephrologist Compensation Report 2018

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; male and female nephrologists reported that they work part-time at a lower average rate than physicians overall.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

All nephrologists, whether employed or self-employed, were asked about their benefits this year. The highest percentages said they receive liability coverage, employer-subsidized health insurance, and paid time off. Very few nephrologists reported that they receive no benefits.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Nephrologists fell near the middle among physicians who believe that they are fairly compensated, congruent with their relative compensation. Specialists' satisfaction and compensation do not always coincide. 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 Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

This year, the Medscape survey asked nephrologists who reported that they are not satisfied with their compensation how large an increase they feel they deserve. More than three quarters said they feel that they should be earning between 11% and 50% more.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

More than one half of nephrologists reported that they are paid through an insurance carrier, with just under one half saying they are reimbursed on a fee-for-service basis. More than one third 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 very 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]

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Medscape Nephrologist 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. Nephrologists were in the upper group of physicians who reported participation in MIPS.

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Medscape Nephrologist 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, generally through CMS initiatives. Nephrologists reported a higher participation rate compared with other specialties in this payment model, with participation overall lower in APMs than in MIPS.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

In this year's survey, a minority of nephrologists said they would drop insurers that pay poorly. Over one third of those who reported that they would not said that doing so would be inappropriate.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

In spite of billing and other administrative challenges, most nephrologists surveyed said they will continue to take Medicare and Medicaid patients. Virtually no nephrologists indicated that they would stop taking on or drop patients who are Medicare and Medicaid recipients, although about one tenth reported that they are undecided.

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Medscape Nephrologist Compensation Report 2018

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 nephrologists. Two thirds, however, said they are unsure about whether they will participate.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Anecdotally, physicians have complained about the effect of the Affordable Care Act on their incomes, but results from this year's survey suggest that 10% of nephrologists who participate in an exchange have experienced a decrease.

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Medscape Nephrologist 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, most nephrologists reported that they occasionally or regularly have such discussions with their patients.

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Medscape Nephrologist 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 nephrologists, however, reported that they do not charge patients who miss an appointment without providing notification.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Whereas just under two thirds of nephrologists reported that they spend 30 to 45 hours each week with patients, one third spend more than 45 hours. The latter percentage, however, is lower than in the two prior years' reports.

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Medscape Nephrologist 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 nephrologists reported that they spend 13 to 24 minutes.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Bureaucratic tasks remain the primary cause of burnout among physicians, and over two thirds of nephrologists reported this year that they spend 10 hours or more per week on paperwork and administration.

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Medscape Nephrologist 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. Even so, nearly three fifths of employed nephrologists said that they are seeking promotion this year.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Among nephrologists, 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 Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Nephrologists most often named being very good at what they do as the most rewarding aspect of their job, followed by relationships with and gratitude from patients and making good money. Very small percentages cited pride in their profession and teaching.

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Medscape Nephrologist 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 nephrologist's job. Working long hours followed. Almost no nephrologists chose concern over being sued.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Despite all of the current challenges, two thirds of nephrologists said that they would choose medicine again, although this places them near the lowest end among physicians who would do so.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Of those who would choose medicine, just over one half of nephrologists said they would choose their specialty again, placing them again among the least likely to make this choice.

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

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Medscape Nephrologist Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

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Medscape Physician Compensation Report 2018

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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