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Medscape Ob/Gyn 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. Ob/gyns 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 Ob/Gyn 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. Plastic surgeons, orthopedists, and cardiologists were among the top earners this year. Ob/gyns were below the middle. The lowest-earning specialties were the same as they were 5 years ago in Medscape's 2013 Compensation Report.

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Medscape Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Compensation for ob/gyns 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 Ob/Gyn 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. Foreign-trained ob/gyns had higher compensation compared with those who were US-trained, according to this year's survey.

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Medscape Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Among ob/gyns, there is an observed gender disparity in some racial or ethnic groups. Men only outnumber women among Hispanic/Latino ob/gyns. In all other racial or ethnic groups, female ob/gyns predominate.

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Medscape Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

The difference in compensation between employed and self-employed ob/gyns is considerable. 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 Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Far more ob/gyns 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 Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

This year, as in all previous years, the male ob/gyns whom 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 Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

More female ob/gyns 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 Ob/Gyn 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. Among ob/gyns, little difference is observed between the percentage of part-time men and women.

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Medscape Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

The great majority of ob/gyns this year say they receive liability coverage and employer-subsidized health insurance. About two thirds receive paid time off and employer-subsidized dental insurance. Fewer have vision insurance and retirement plans with employer matches. Very few ob/gyns reported that they receive no benefits. Note that all ob/gyns, whether employed or self-employed, were asked about their benefits.

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Medscape Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Nearly three fifths of ob/gyns surveyed believe that they are fairly compensated, falling slightly below 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 Ob/Gyn 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 one third each of ob/gyns feel that they should be earning either an additional 11% to 25% or 26% to 50%.

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Medscape Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

The majority of ob/gyns reported that they are paid through an insurance carrier, with 42% being reimbursed on a fee-for-service basis. Under one quarter 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 7% have adopted the direct primary care model, which is gaining popularity among primary care physicians.[3]

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Medscape Ob/Gyn 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. Ob/gyns reported participation in MIPS toward the bottom relative to all physicians surveyed.

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Medscape Ob/Gyn 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. Ob/gyns 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 Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

In this year's survey, nearly 20% of ob/gyns said they would drop insurers that pay poorly. One quarter needed all the payers they could get. The remaining ob/gyns either said the behavior would be inappropriate or had other reasons for responding "no."

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Medscape Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

In spite of billing and other administrative challenges, most ob/gyns surveyed said they will continue to take Medicare and Medicaid patients. Twenty 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 Ob/Gyn 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 the percentages plateau of ob/gyns who do or do not participate in the exchanges.

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Medscape Ob/Gyn 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 15% of ob/gyns who participate in an exchange have experienced a decrease.

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Medscape Ob/Gyn 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 ob/gyns reported that they occasionally or regularly have such discussions with their patients.

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Medscape Ob/Gyn 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 ob/gyns reported that they do not charge patients who miss an appointment without providing notification. Of note, however, more than one third of ob/gyns in solo practice charge their no-show patients.

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Medscape Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

More than one half of ob/gyns reported that they spend 30 to 45 hours each week with patients, while about one third spend more than 45 hours, which is similar to the percentages reported in the previous year's report.

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Medscape Ob/Gyn 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. Nearly two thirds of ob/gyns reported that they spend between 13 and 24 minutes.

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Medscape Ob/Gyn 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 ob/gyns reported this year that they spend 10 hours or more per week on paperwork and administration.

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Medscape Ob/Gyn 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 about one third of employed ob/gyns seeking promotion, according to this year's survey.

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Medscape Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Among ob/gyns, slightly 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 Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Ob/gyns 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 good at what they do. Only 1% could not find anything positive about their job.

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Medscape Ob/Gyn 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 ob/gyn's job, followed by working long hours and worrying about being sued.

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Medscape Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

Although ob/gyns were less likely than many 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, appear to make up for the difficulties they face in their jobs.

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Medscape Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

As in previous years, ob/gyns are somewhat less likely than other physicians to choose their specialty again if given the opportunity to do so.

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Medscape Ob/Gyn Compensation Report 2018

Carol Peckham | April 18, 2018 | Contributor Information

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Medscape Ob/Gyn 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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